Healthcare Provider Details

I. General information

NPI: 1912765025
Provider Name (Legal Business Name): TAKAYUKI ONISHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH AVE
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1030
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax:
Mailing address:
  • Phone: 212-241-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number347638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: