=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619208907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIPPON SHINRYOJO LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2010
-----------------------------------------------------
Last Update Date | 01/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 E 40TH ST SUITE 1200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-0941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-213-3100
-----------------------------------------------------
Fax | 212-213-4100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 355 MCCLOUD DR
-----------------------------------------------------
City | FORT LEE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07024-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-461-2734
-----------------------------------------------------
Fax | 201-461-2734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JAMES H TACHIBANA
-----------------------------------------------------
Credential | D.P.M
-----------------------------------------------------
Telephone | 917-952-7405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | N003495
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------