Basic Information
| Provider Information | |||||||||
| NPI: | 1003233966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OOKA | ||||||||
| FirstName: | KOHTARO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 E 98TH ST | ||||||||
| Address2: | STE 11C-3 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474144929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 530 1ST AVE # HCC4G | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465012465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 302700 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.