Provider Demographics
NPI:1598716912
Name:WIN, PE THET (MD)
Entity Type:Individual
Prefix:
First Name:PE
Middle Name:THET
Last Name:WIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 JEFFERSON STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:18428-1523
Mailing Address - Country:US
Mailing Address - Phone:845-791-8800
Mailing Address - Fax:845-791-7051
Practice Address - Street 1:64 JEFFERSON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-791-8800
Practice Address - Fax:845-791-7051
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY22674112084P0800X
NYMD2267412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94169Medicare UPIN
NY3218E1Medicare ID - Type Unspecified