Provider Demographics
NPI:1104486240
Name:TSUSUE, HIROMI
Entity type:Individual
Prefix:
First Name:HIROMI
Middle Name:
Last Name:TSUSUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HIROMI
Other - Middle Name:
Other - Last Name:TSUSUE-TABANDERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:319 WEST 48TH STREET
Mailing Address - Street 2:APT 324
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1331
Mailing Address - Country:US
Mailing Address - Phone:917-743-0749
Mailing Address - Fax:
Practice Address - Street 1:312 W 49TH ST APT 1FE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7368
Practice Address - Country:US
Practice Address - Phone:917-743-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022963-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022963-1OtherNY STATE OFFICE OF PROFESSIONALS LICENSING