Healthcare Provider Details

I. General information

NPI: 1447598677
Provider Name (Legal Business Name): MAKOTO TOKIWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 04/04/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FT WASHINGTN AVE FL 4
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

202 W 107TH ST APT 2R
NEW YORK NY
10025-3085
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4682
  • Fax:
Mailing address:
  • Phone: 646-339-2495
  • 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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number288853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: