Provider Demographics
NPI:1467199604
Name:RATANACHAIYAPHAN, SUTIKANT (LAC)
Entity Type:Individual
Prefix:
First Name:SUTIKANT
Middle Name:
Last Name:RATANACHAIYAPHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 5TH AVE - SUITE 6L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3996
Mailing Address - Country:US
Mailing Address - Phone:914-400-1500
Mailing Address - Fax:914-478-8781
Practice Address - Street 1:1 HANSON PL STE 704
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11243-2907
Practice Address - Country:US
Practice Address - Phone:718-857-1900
Practice Address - Fax:718-857-1902
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005960171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist