Basic Information
| Provider Information | |||||||||
| NPI: | 1083055958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAKAHASHI | ||||||||
| FirstName: | HIDEO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115805443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166323359 | ||||||||
| FaxNumber: | 5166323355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115805443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166323359 | ||||||||
| FaxNumber: | 5166323355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 292639 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.