Provider Demographics
NPI:1639146616
Name:YAMASHIRO, DARRELL J
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:J
Last Name:YAMASHIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1812
Mailing Address - Country:US
Mailing Address - Phone:201-664-0639
Mailing Address - Fax:
Practice Address - Street 1:COLUMBIA UNVERSITY DEPARTMENT PEDIATRICS
Practice Address - Street 2:3959 BROADWAY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:221-304-7297
Practice Address - Fax:212-544-1974
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2064472080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01795440Medicaid
NY01795440Medicaid
NY5Z7731Medicare ID - Type Unspecified