Healthcare Provider Details

I. General information

NPI: 1649342627
Provider Name (Legal Business Name): WILLIAM TATSUO KASUMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. TATSUO KASUMI

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HACKENSACK AVE FL 5
HACKENSACK NJ
07601-6406
US

IV. Provider business mailing address

401 HACKENSACK AVE FL 5
HACKENSACK NJ
07601-6406
US

V. Phone/Fax

Practice location:
  • Phone: 201-678-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210028
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06876200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: