Individual
THAO PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
675 3RD AVE FL 5, NEW YORK, NY 10017-5731
(212) 871-0621
Mailing address
317 MARGARET ST, HERKIMER, NY 13350-1725
(315) 723-7327
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
039089
NY
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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