Pride Medical, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PRIDE MEDICAL, PLLC

Practice address

3875 Broadway
Unit B
New York, NY 10032-1567

Phone

(917) 656-2951

NPI assigned

May 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Punyadech Photangtham, MDNPI 1083700926

Title

Owner

Phone

(917) 656-2951

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Punyadech Photangtham, MD

  • Family Medicine Physician
  • New York, NY
  • NPI 1083700926
  Medicare reassignment NPD Authorized official
• Giosely M Collado, RPAC

  • Physician Assistant
  • New York, NY
  • NPI 1649475021
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448236800000",
    "number": "1922214600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3875 BROADWAY",
            "address_2": "UNIT B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321567",
            "telephone_number": "917-656-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 BROADWAY",
            "address_2": "UNIT B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321567",
            "telephone_number": "917-656-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2015-11-23",
        "status": "A",
        "authorized_official_last_name": "PHOTANGTHAM",
        "authorized_official_first_name": "PUNYADECH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-656-2951",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1083700926",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Price
• Robin Carol Price, LCSW
• Jessica Prichett
• Victoria Veronica Pricop, DMD
• Pridakt Joelic LLC
• Pride Optical
• Pridecare, Inc.
• Amianta Pridgeon, MSW
• Nikolas Forest Priest, PHD
• William D. Priester, M.D.

• Primary Care Clinic/Center in New York, NY
• Providers in New York, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.