# SUPAPORN PATHUMANON INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689583924
- **Authorized official:** SUPAPORN PATHUMANON PMHNP (PRESIDENT)
- **Authorized official phone:** (347) 845-1857

## Contact information

- **Practice address:** 814 LARCHMONT ACRES APT D, LARCHMONT, NY 10538-7370
- **Practice address phone:** (347) 845-1857
- **Mailing address:** 814 LARCHMONT ACRES APT D, LARCHMONT, NY 10538-7370
- **Mailing address phone:** (347) 845-1857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/02/2026
- **Last updated:** 09/02/2026