Provider Demographics
NPI:1447691407
Name:HATANO, MIHO (MD)
Entity type:Individual
Prefix:
First Name:MIHO
Middle Name:
Last Name:HATANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 31ST ST
Mailing Address - Street 2:APT 25C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 W 31ST ST
Practice Address - Street 2:APT 25C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3414
Practice Address - Country:US
Practice Address - Phone:347-423-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP89191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics