Provider Demographics
NPI:1841582681
Name:ITAGAKI, SHINOBU (MD)
Entity Type:Individual
Prefix:DR
First Name:SHINOBU
Middle Name:
Last Name:ITAGAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 97TH ST APT 24
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7221
Mailing Address - Country:US
Mailing Address - Phone:646-300-0627
Mailing Address - Fax:
Practice Address - Street 1:121 E 97TH ST APT 24
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7221
Practice Address - Country:US
Practice Address - Phone:646-300-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)