Provider Demographics
NPI:1215224480
Name:SHIMOJI, TORU
Entity Type:Individual
Prefix:
First Name:TORU
Middle Name:
Last Name:SHIMOJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 WETHEROLE ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3049
Mailing Address - Country:US
Mailing Address - Phone:317-801-4158
Mailing Address - Fax:
Practice Address - Street 1:6412 WETHEROLE ST
Practice Address - Street 2:APT 2C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3049
Practice Address - Country:US
Practice Address - Phone:317-801-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006616213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist