Provider Demographics
NPI:1083003743
Name:SHIMIZU, EMI
Entity Type:Individual
Prefix:
First Name:EMI
Middle Name:
Last Name:SHIMIZU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HANA RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2046
Mailing Address - Country:US
Mailing Address - Phone:732-407-6945
Mailing Address - Fax:
Practice Address - Street 1:345E. 24TH ST
Practice Address - Street 2:916S
Practice Address - City:NEW YROK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-998-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics