Provider Demographics
NPI:1508064536
Name:SARABANCHONG, VORAVUT ORD (MD)
Entity Type:Individual
Prefix:
First Name:VORAVUT
Middle Name:ORD
Last Name:SARABANCHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-5994
Mailing Address - Fax:212-241-3833
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-5994
Practice Address - Fax:212-241-3833
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207729207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01810402Medicaid
NY0389FEMedicare Oscar/Certification
NY3T38308171Medicare PIN
NY01810402Medicaid