Provider Demographics
NPI:1740354232
Name:ORCHID ISLE NEUROLOGY, LLC
Entity type:Organization
Organization Name:ORCHID ISLE NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORIFUSA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANEGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:808-885-9308
Mailing Address - Street 1:PO BOX 437319
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7143
Mailing Address - Country:US
Mailing Address - Phone:808-885-9308
Mailing Address - Fax:808-885-9310
Practice Address - Street 1:67-1123 MAMALAHOA HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8451
Practice Address - Country:US
Practice Address - Phone:808-885-9308
Practice Address - Fax:808-885-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI130152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100371Medicaid
HIDD5219OtherRAILROAD MEDICARE GROUP
HI0000252148OtherHMSA ID
HIDD5219OtherRAILROAD MEDICARE GROUP