Healthcare Provider Details

I. General information

NPI: 1427265032
Provider Name (Legal Business Name): TOMONORI NAKAGAMA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 MADISON AVE RM 700
NEW YORK NY
10017-1166
US

IV. Provider business mailing address

424 MADISON AVE RM 700
NEW YORK NY
10017-1166
US

V. Phone/Fax

Practice location:
  • Phone: 212-204-8567
  • Fax: 212-808-5510
Mailing address:
  • Phone: 212-204-8567
  • Fax: 212-808-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number55771
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number256704
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number55771
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number256704
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number256704
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number55771
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: