Provider Demographics
NPI:1679646343
Name:SARABANCHONG, VIYADA (MD)
Entity Type:Individual
Prefix:
First Name:VIYADA
Middle Name:
Last Name:SARABANCHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 ROUTE 45
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3520
Mailing Address - Country:US
Mailing Address - Phone:845-354-3700
Mailing Address - Fax:845-354-5573
Practice Address - Street 1:974 ROUTE 45
Practice Address - Street 2:SUITE 2000
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3520
Practice Address - Country:US
Practice Address - Phone:845-354-3700
Practice Address - Fax:845-354-5573
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195951207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01517046Medicaid
NY3V6841Medicare ID - Type Unspecified
NYF82094Medicare UPIN