Healthcare Provider Details

I. General information

NPI: 1023322054
Provider Name (Legal Business Name): HIROMI SUZUKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX A
FPO AP
96350-9998
US

IV. Provider business mailing address

3-17-2 HIGASHI-SHINAGAWA #204
SHINAGAWA-KU TOKYO
1400002
JP

V. Phone/Fax

Practice location:
  • Phone: 315-243-3289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number626354-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: