Ichise, Masanori
Ichise, Masanori is an individual health care provider with primary practice located at 630 W 168Th St # Mc28 , New York NY 10032-3725. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Nuclear Radiology. Allopathic & Osteopathic Physicians / Nuclear Radiology is his primary health care specialty. Ichise, Masanori can be contacted via phone (212) 305-1948.Contact Information
Primary practice address
630 W 168Th St # Mc28
New York NY 10032-3725
Phone: (212) 305-1948
Fax: (212) 305-5777
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 238962 | New York |
| Allopathic & Osteopathic Physicians / Nuclear Radiology | 2085N0904X | 238962-1 | New York |
Profile Details
| NPI number | 1598707598 |
|---|---|
| LBN Legal business name | Ichise, Masanori |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2006 |
| Last updated | Nov 27th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598707598 | NPPES |
| New York | Other | W35021 | MEDICARE GROUP # |
| New York | Other | 02186203 | MEDICARE GROUP # |
| New York | MEDICAID | 2744470 | MEDICARE GROUP # |
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