Provider Demographics
NPI:1952468852
Name:NAKAO, NAOMI L (MD)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:L
Last Name:NAKAO
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 1:303 E 57TH ST # 36C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2947
Mailing Address - Country:US
Mailing Address - Phone:212-772-7100
Mailing Address - Fax:212-772-1621
Practice Address - Street 1:992 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0101
Practice Address - Country:US
Practice Address - Phone:212-772-7100
Practice Address - Fax:212-772-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD47711Medicare UPIN
NY54A081Medicare ID - Type Unspecified