Healthcare Provider Details

I. General information

NPI: 1457865735
Provider Name (Legal Business Name): HOSHIYUKI IIDA APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 11/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2191
US

IV. Provider business mailing address

59 DAVIS AVE
BLOOMFIELD NJ
07003-4116
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-3033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number26NJ00532800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: