Provider Demographics
NPI:1932679321
Name:RATTANASRIAMPIPONG, NATWADEE (MT)
Entity Type:Individual
Prefix:
First Name:NATWADEE
Middle Name:
Last Name:RATTANASRIAMPIPONG
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:NATWADEE
Other - Middle Name:
Other - Last Name:LIPPOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:49 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5523
Mailing Address - Country:US
Mailing Address - Phone:682-628-9514
Mailing Address - Fax:
Practice Address - Street 1:49 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5523
Practice Address - Country:US
Practice Address - Phone:682-628-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027189225700000X
CT007710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty