Healthcare Provider Details

I. General information

NPI: 1386964849
Provider Name (Legal Business Name): IWAHARA ENDOSCOPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 79TH ST OFC 1C
NEW YORK NY
10075-0319
US

IV. Provider business mailing address

120 E 79TH ST OFC 1C
NEW YORK NY
10075-0319
US

V. Phone/Fax

Practice location:
  • Phone: 212-879-2328
  • Fax: 212-879-1933
Mailing address:
  • Phone: 212-879-2328
  • Fax: 212-879-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MAKOTO IWAHARA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 212-879-2328