MEDICARE: MS. HIROMI WADA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	174400000X	Specialist	1336271	NY

General Provider Information

NPI Number	:	1528435849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HIROMI WADA

Provider Business Mailing Address
First Line	:	7236 112TH ST APT 314
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5456
Country	:	US
Telephone Number	:	914-826-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	7236 112TH ST APT 314
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5456
Country	:	US
Telephone Number	:	914-826-5673
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	05/11/2021

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