Healthcare Provider Details

I. General information

NPI: 1407023914
Provider Name (Legal Business Name): MIKI EMILIA MOCHIZUKI TAKAHASHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HENRY ST APT 1G
BROOKLYN NY
11201
US

IV. Provider business mailing address

86 HALSTEAD AVE APT 1C
HARRISON NY
10528-4129
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-4924
  • Fax: 718-522-4954
Mailing address:
  • Phone: 347-603-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number268764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: