Provider Demographics
NPI:1386868610
Name:HARADA, JUMPEI (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JUMPEI
Middle Name:
Last Name:HARADA
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 BROADWAY # MC1915
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6907
Mailing Address - Country:US
Mailing Address - Phone:212-854-3178
Mailing Address - Fax:212-854-4597
Practice Address - Street 1:3030 BROADWAY # MC1915
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6907
Practice Address - Country:US
Practice Address - Phone:212-854-3178
Practice Address - Fax:212-854-4597
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer