Provider Demographics
NPI:1649342627
Name:KASUMI, WILLIAM TATSUO (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TATSUO
Last Name:KASUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TATSUO
Other - Middle Name:
Other - Last Name:KASUMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 HACKENSACK AVE
Mailing Address - Street 2:FL 5
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 HACKENSACK AVE
Practice Address - Street 2:FL 5
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6406
Practice Address - Country:US
Practice Address - Phone:201-678-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210028207R00000X
NJ25MA06876200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH08786Medicare UPIN
NY2756P1Medicare ID - Type Unspecified
NJ034553Medicare ID - Type Unspecified