Basic Information
| Provider Information | |||||||||
| NPI: | 1033614631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IKUINE | ||||||||
| FirstName: | TOMOKO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 106 ST | ||||||||
| Address2: | ATTN MEDICAL DEPT | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100253923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128705752 | ||||||||
| FaxNumber: | 2128704905 | ||||||||
| Practice Location | |||||||||
| Address1: | 947 COLUMBUS AVE APT 3B | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100253180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466623740 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 313383-01 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.