Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 292639 | NY |
NPI | 1083055958 |
---|---|
Provider Name | Hideo Takahashi |
First Address | Valley Stream, NY 11580-5443 |
Second Address | Valley Stream, NY 11580-5443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 05/10/2020 |