Provider Demographics
NPI:1518040039
Name:PHUNTSOK, KALSANG
Entity Type:Individual
Prefix:
First Name:KALSANG
Middle Name:
Last Name:PHUNTSOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4428
Mailing Address - Country:US
Mailing Address - Phone:914-245-5180
Mailing Address - Fax:914-245-5197
Practice Address - Street 1:1940 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-245-5180
Practice Address - Fax:914-245-5197
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0222879Medicaid
NY0222879Medicaid
G91300Medicare UPIN