Healthcare Provider Details

I. General information

NPI: 1609281906
Provider Name (Legal Business Name): JUNKO NISHITA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVENUE MAIMONIDES MEDICAL CENTER
BROOKLYN NY
11219
US

IV. Provider business mailing address

4802 10TH AVENUE MAIMONIDES MEDICAL CENTER
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-6879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: