Provider Demographics
NPI:1235423195
Name:MATSUKI, TAKASHI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAKASHI
Middle Name:
Last Name:MATSUKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W 86TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3663
Mailing Address - Country:US
Mailing Address - Phone:201-809-3508
Mailing Address - Fax:201-331-5975
Practice Address - Street 1:5 W 86TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3603
Practice Address - Country:US
Practice Address - Phone:347-632-0556
Practice Address - Fax:201-941-4599
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA093870002084P0800X
NY2767902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04047054Medicaid