Provider Demographics
NPI:1821252024
Name:FUJIWARA, MIWA (M,D,)
Entity Type:Individual
Prefix:
First Name:MIWA
Middle Name:
Last Name:FUJIWARA
Suffix:
Gender:F
Credentials:M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2770
Mailing Address - Country:US
Mailing Address - Phone:631-598-5864
Mailing Address - Fax:631-598-5866
Practice Address - Street 1:317 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2770
Practice Address - Country:US
Practice Address - Phone:631-598-5864
Practice Address - Fax:631-598-5866
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist