Provider Demographics
NPI:1083013098
Name:TAKESHIGE MEDICAL PC
Entity Type:Organization
Organization Name:TAKESHIGE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UMEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKESHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-340-2425
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-0121
Mailing Address - Country:US
Mailing Address - Phone:917-340-2425
Mailing Address - Fax:201-224-4545
Practice Address - Street 1:535 W 110TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2021
Practice Address - Country:US
Practice Address - Phone:212-864-8888
Practice Address - Fax:212-864-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196739207R00000X, 207RB0002X, 207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty