Healthcare Provider Details

I. General information

NPI: 1972575454
Provider Name (Legal Business Name): NORIHITO ONISHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 LOCUST AVE
MT MORRIS PA
15349
US

IV. Provider business mailing address

PO. BOX 378
MT MORRIS PA
15349
US

V. Phone/Fax

Practice location:
  • Phone: 888-262-0021
  • Fax: 724-324-5436
Mailing address:
  • Phone: 888-262-0021
  • Fax: 724-324-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1822
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05015849
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: