Provider Demographics
NPI:1629486519
Name:MYINT, THIRI (MD)
Entity type:Individual
Prefix:
First Name:THIRI
Middle Name:
Last Name:MYINT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 37TH AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6614
Mailing Address - Country:US
Mailing Address - Phone:347-735-1571
Mailing Address - Fax:
Practice Address - Street 1:7827 37TH AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6614
Practice Address - Country:US
Practice Address - Phone:347-735-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06353002Medicaid
OR93-0505325OtherMEDICARE