Healthcare Provider Details

I. General information

NPI: 1669449393
Provider Name (Legal Business Name): FUMIYO AKAZAWA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SOUTH CENTRAL PARK AVE JAPANESE MEDICAL PRACTICE C/O DOCS
HARTSDALE NY
10530
US

IV. Provider business mailing address

465 COLUMBUS AVE DOCS CONTINUUM MEDICAL GROUP
VALHALLA NY
10595
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-9300
  • Fax: 914-997-2418
Mailing address:
  • Phone: 914-749-7000
  • Fax: 914-769-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number212052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: