Healthcare Provider Details

I. General information

NPI: 1578705935
Provider Name (Legal Business Name): TAKAMASA HIGASHIMORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 08/07/2026
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4371
  • Fax: 585-922-7485
Mailing address:
  • Phone: 585-922-4371
  • Fax: 585-922-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number300375
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number300375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: