Provider Demographics
NPI:1649648320
Name:HAGIWARA, TOYOMICHI
Entity type:Individual
Prefix:
First Name:TOYOMICHI
Middle Name:
Last Name:HAGIWARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3502
Mailing Address - Country:US
Mailing Address - Phone:914-406-9611
Mailing Address - Fax:
Practice Address - Street 1:34 HALL AVE
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-3502
Practice Address - Country:US
Practice Address - Phone:914-406-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322698-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFE53021EMedicaid