Provider Demographics
NPI:1982785358
Name:NAKAZAWA, HIROSHI (MD)
Entity Type:Individual
Prefix:
First Name:HIROSHI
Middle Name:
Last Name:NAKAZAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SANATORIAM ROAD
Mailing Address - Street 2:BLDG F
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2308
Mailing Address - Country:US
Mailing Address - Phone:845-364-2378
Mailing Address - Fax:845-364-2381
Practice Address - Street 1:150 SANATORIAM ROAD
Practice Address - Street 2:BLDG F
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2308
Practice Address - Country:US
Practice Address - Phone:845-364-2378
Practice Address - Fax:845-364-2381
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093635207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B20194Medicare UPIN
NY924001Medicare ID - Type Unspecified