Provider Demographics
NPI:1386964849
Name:IWAHARA ENDOSCOPY, PLLC
Entity type:Organization
Organization Name:IWAHARA ENDOSCOPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKOTO
Authorized Official - Middle Name:
Authorized Official - Last Name:IWAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-879-2328
Mailing Address - Street 1:120 E 79TH ST OFC 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0319
Mailing Address - Country:US
Mailing Address - Phone:212-879-2328
Mailing Address - Fax:212-879-1933
Practice Address - Street 1:120 E 79TH ST OFC 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0319
Practice Address - Country:US
Practice Address - Phone:212-879-2328
Practice Address - Fax:212-879-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3368OtherAAAASF, INC.