Provider Demographics
NPI:1427118850
Name:OHSUMI, FAY MIZUE (MD)
Entity type:Individual
Prefix:DR
First Name:FAY
Middle Name:MIZUE
Last Name:OHSUMI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:117 E 84TH ST
Mailing Address - Street 2:SUITE #1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0902
Mailing Address - Country:US
Mailing Address - Phone:212-288-8121
Mailing Address - Fax:212-288-6311
Practice Address - Street 1:117 E 84TH ST
Practice Address - Street 2:SUITE #1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0902
Practice Address - Country:US
Practice Address - Phone:212-288-8121
Practice Address - Fax:212-288-6311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY167316207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01768625Medicaid
NYG57274Medicare UPIN
NY01768625Medicaid