Healthcare Provider Details

I. General information

NPI: 1366880049
Provider Name (Legal Business Name): SHUNPEI OKOCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 5TH AVE
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1184 5TH AVE
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9500
  • Fax:
Mailing address:
  • Phone: 212-241-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number280668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: