Healthcare Provider Details

I. General information

NPI: 1306998901
Provider Name (Legal Business Name): TAKEKO TAKESHIGE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH STREET
BRONX NY
10451
US

IV. Provider business mailing address

PO BOX 3514
WAYNE NJ
07474-3514
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number215907
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: