Healthcare Provider Details

I. General information

NPI: 1275286502
Provider Name (Legal Business Name): MAKOTO HIBINO MD, MPH, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD FL ACP1
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

100 WOODS RD FL ACP1
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-8793
  • Fax:
Mailing address:
  • Phone: 914-493-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number327688
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: