Healthcare Provider Details

I. General information

NPI: 1104260355
Provider Name (Legal Business Name): SHIORI KINOSHITA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST FL 2
NEW YORK NY
10028-3001
US

IV. Provider business mailing address

786 GEORGE ST
TEANECK NJ
07666-5354
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6585
  • Fax: 212-731-3391
Mailing address:
  • Phone: 646-549-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340869
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: