Provider Demographics
NPI:1508801838
Name:FUJISHIGE, NEAL KAZUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:KAZUO
Last Name:FUJISHIGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7501
Mailing Address - Country:US
Mailing Address - Phone:212-989-5253
Mailing Address - Fax:212-989-5263
Practice Address - Street 1:20 W 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7501
Practice Address - Country:US
Practice Address - Phone:212-989-5253
Practice Address - Fax:212-989-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0395951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02619625Medicaid