Provider Demographics
NPI:1245341833
Name:TAKESHIGE, UMEKO (MD)
Entity type:Individual
Prefix:DR
First Name:UMEKO
Middle Name:
Last Name:TAKESHIGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 41ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3901
Mailing Address - Country:US
Mailing Address - Phone:718-278-5100
Mailing Address - Fax:718-278-6757
Practice Address - Street 1:3117 41ST ST
Practice Address - Street 2:FL 1
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3901
Practice Address - Country:US
Practice Address - Phone:718-278-5100
Practice Address - Fax:718-278-6757
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196739207RG0100X, 207RI0008X
RIMD12978207RG0100X
NYNY196739207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG82835Medicare UPIN