MEDICARE: TAKASHI WAKAMORE, MD

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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1982759346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKASHI WAKAMORE, MD

Provider Business Mailing Address
First Line	:	810 ABBOTT BLVD
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4151
Country	:	US
Telephone Number	:	201-592-8555
Fax Number	:	201-592-8501

Provider Business Practice Location Address
First Line	:	810 ABBOTT BLVD
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4151
Country	:	US
Telephone Number	:	201-592-8555
Fax Number	:	201-592-8501

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	TAKASHI WAKAMORI
Credential	:	MD
Telephone Number	:	201-592-8555

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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