MEDICARE: TOMOKO NISHIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	055578	NY

General Provider Information

NPI Number	:	1114044195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMOKO NISHIDA

Provider Business Mailing Address
First Line	:	250 W 90TH ST
Second Line	:	APT 17A
City	:	NEW YORK
State	:	NY
Zip	:	10024-1100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W 90TH ST
Second Line	:	APT 10J
City	:	NEW YORK
State	:	NY
Zip	:	10024-1100
Country	:	US
Telephone Number	:	212-784-1080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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Directions to “ TOMOKO NISHIDA ” Practice Location

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