Healthcare Provider Details

I. General information

NPI: 1659970853
Provider Name (Legal Business Name): HAJIME ICHIKAWA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 1/2 WOLDEN RD APT B1-5
OSSINING NY
10562-5311
US

IV. Provider business mailing address

38 1/2 WOLDEN RD APT B1-5
OSSINING NY
10562-5311
US

V. Phone/Fax

Practice location:
  • Phone: 914-426-7570
  • Fax:
Mailing address:
  • Phone: 914-426-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number733781
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: