Healthcare Provider Details

I. General information

NPI: 1427118850
Provider Name (Legal Business Name): FAY MIZUE OHSUMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E 84TH ST SUITE #1B
NEW YORK NY
10028-0902
US

IV. Provider business mailing address

117 E 84TH ST SUITE #1B
NEW YORK NY
10028-0902
US

V. Phone/Fax

Practice location:
  • Phone: 212-288-8121
  • Fax: 212-288-6311
Mailing address:
  • Phone: 212-288-8121
  • Fax: 212-288-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number167316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: