Provider Demographics
NPI:1265171565
Name:TSUKADA, HIROKO
Entity type:Individual
Prefix:MS
First Name:HIROKO
Middle Name:
Last Name:TSUKADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1535
Mailing Address - Country:US
Mailing Address - Phone:347-860-5611
Mailing Address - Fax:
Practice Address - Street 1:275 N MIDDLETOWN RD STE 1D
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1189
Practice Address - Country:US
Practice Address - Phone:347-860-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06-041221700000X
NY001784-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty