Healthcare Provider Details

I. General information

NPI: 1063854487
Provider Name (Legal Business Name): MIYUKI KOBAYASHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 5TH AVE SUITE #2001
NEW YORK NY
10001-7604
US

IV. Provider business mailing address

244 5TH AVE SUITE #2001
NEW YORK NY
10001-7604
US

V. Phone/Fax

Practice location:
  • Phone: 347-766-0277
  • Fax:
Mailing address:
  • Phone: 347-766-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: