Provider Demographics
NPI:1790143147
Name:MYO THANT MD PLLC
Entity Type:Organization
Organization Name:MYO THANT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYO
Authorized Official - Middle Name:
Authorized Official - Last Name:THANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-361-6038
Mailing Address - Street 1:8605 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3921
Mailing Address - Country:US
Mailing Address - Phone:718-361-6038
Mailing Address - Fax:
Practice Address - Street 1:8605 51ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3921
Practice Address - Country:US
Practice Address - Phone:718-361-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212485261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190178Medicaid