Healthcare Provider Details

I. General information

NPI: 1154398568
Provider Name (Legal Business Name): ALEX JENNY KY-MIYASAKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEX J KY MD

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAST 98TH STREET 14TH FL
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

BOX 1263 1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1303
  • Fax: 212-534-2654
Mailing address:
  • Phone: 212-241-1303
  • Fax: 212-534-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number203197
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number203197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: