1114378411 NPI number — HIDEYUKI OKUWA ATC

Table of content: HIDEYUKI OKUWA ATC (NPI 1114378411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114378411 NPI number — HIDEYUKI OKUWA ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKUWA
Provider First Name:
HIDEYUKI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114378411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
286 GRAFF AVE
Provider Second Line Business Mailing Address:
APT 1
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10465-3266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-899-9897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 PENNYFIELD AVE
Provider Second Line Business Practice Location Address:
ATHLETICS
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10465-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-409-7240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT4654 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 090702220 . This is a "BOC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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