Provider Demographics
NPI:1801825096
Name:ROMSAITONG, PANUS (MD)
Entity Type:Individual
Prefix:
First Name:PANUS
Middle Name:
Last Name:ROMSAITONG
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 1:440 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1838
Mailing Address - Country:US
Mailing Address - Phone:718-896-5255
Mailing Address - Fax:718-896-5270
Practice Address - Street 1:9876 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4511
Practice Address - Country:US
Practice Address - Phone:718-897-0300
Practice Address - Fax:718-897-3330
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01914878Medicaid
NYG85056Medicare UPIN
NY40Z091Medicare PIN
NY06586GMedicare ID - Type Unspecified