Provider Demographics
NPI:1043339492
Name:NIHON POD&ACU PRACTICE, LLC
Entity Type:Organization
Organization Name:NIHON POD&ACU PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-683-0041
Mailing Address - Street 1:18 E 41ST ST
Mailing Address - Street 2:FL1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6222
Mailing Address - Country:US
Mailing Address - Phone:212-683-0041
Mailing Address - Fax:212-683-3414
Practice Address - Street 1:18 E 41ST ST
Practice Address - Street 2:FL1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6222
Practice Address - Country:US
Practice Address - Phone:212-683-0041
Practice Address - Fax:212-683-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006128213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV08767Medicare UPIN
NYPK4531Medicare ID - Type Unspecified