Provider Demographics
NPI:1043689375
Name:MEGUMI OMONISHI, PH.D., PSYCHOLOGIST, PLLC
Entity Type:Organization
Organization Name:MEGUMI OMONISHI, PH.D., PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OMONISHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-575-8910
Mailing Address - Street 1:15 W 44TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6611
Mailing Address - Country:US
Mailing Address - Phone:212-575-8910
Mailing Address - Fax:212-575-1830
Practice Address - Street 1:15 W 44TH ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6611
Practice Address - Country:US
Practice Address - Phone:212-575-8910
Practice Address - Fax:212-575-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty