Provider Demographics
NPI:1215584529
Name:ISHIBASHI, ATSUKO
Entity Type:Individual
Prefix:
First Name:ATSUKO
Middle Name:
Last Name:ISHIBASHI
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 1:420 E 54TH ST APT 1513
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5390
Mailing Address - Country:US
Mailing Address - Phone:347-673-9337
Mailing Address - Fax:
Practice Address - Street 1:420 E 54TH ST APT 1513
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5390
Practice Address - Country:US
Practice Address - Phone:347-673-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TK8532772OtherPASSPORT