Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 197666 | NY |
NPI | 1457680720 |
---|---|
Provider Name | Dr. Kenichi Takeshita |
First Address | New York, NY 10128-1251 |
Second Address | New York, NY 10128-1251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2009 |
Last Update Date | 19/11/2012 |