Provider Demographics
NPI:1407023914
Name:MOCHIZUKI TAKAHASHI, MIKI EMILIA (MD)
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:EMILIA
Last Name:MOCHIZUKI TAKAHASHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 HALSTEAD AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-4129
Mailing Address - Country:US
Mailing Address - Phone:347-603-6471
Mailing Address - Fax:
Practice Address - Street 1:145 HENRY ST APT 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-858-4924
Practice Address - Fax:718-522-4954
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268764208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics