PHAISAL MANOMAIVAT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036047988

License Status

NOT RENEWED

Business

First Name

PHAISAL

Last Name

MANOMAIVAT

Suffix

Business Name

PHAISAL MANOMAIVAT MD

Original Issue Date

08/23/1973

Effective Date

08/23/1973

City

POUGHKEEPSIE

State

Zip

12603

County

NEW JERSEY

Ever Disciplined

LastModifiedDate

09/20/2006