Provider Demographics
NPI:1811771405
Name:HASHIMOTO, MINORI
Entity type:Individual
Prefix:
First Name:MINORI
Middle Name:
Last Name:HASHIMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14308 ROOSEVELT AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6117
Mailing Address - Country:US
Mailing Address - Phone:646-265-4617
Mailing Address - Fax:
Practice Address - Street 1:2118 CONEY ISLAND AVE 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2347
Practice Address - Country:US
Practice Address - Phone:718-872-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350893-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily