Provider Demographics
NPI:1760702450
Name:KOH, MISUZU (DO)
Entity Type:Individual
Prefix:DR
First Name:MISUZU
Middle Name:
Last Name:KOH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MISUZU
Other - Middle Name:
Other - Last Name:KAMEYAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:TH530
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:917-399-0764
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:TH530
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:917-399-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11288900207L00000X
NY264575-1207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology