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Organization
SUPAPORN PATHUMANON INC
Active
Organization
SUPAPORN PATHUMANON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUPAPORN PATHUMANON PMHNP (PRESIDENT)
(347) 845-1857
Entity
Organization
Contact information
Practice address
814 LARCHMONT ACRES APT D, LARCHMONT, NY 10538-7370
(347) 845-1857
Mailing address
814 LARCHMONT ACRES APT D, LARCHMONT, NY 10538-7370
(347) 845-1857
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/02/2026
Last updated
09/02/2026
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