=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427068964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J H TACHIBANA DPM PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 12/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 N CENTRAL AVE SUITE 260
-----------------------------------------------------
City | HARTSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10530-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-683-7388
-----------------------------------------------------
Fax | 914-683-8419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 N CENTRAL AVE SUITE 260
-----------------------------------------------------
City | HARTSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10530-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-683-7388
-----------------------------------------------------
Fax | 914-683-8419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES H TACHIBANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-683-7388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | N003495-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------