Individual
SHINICHIRO IKEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4802 10TH AVE, BROOKLYN, NY 11219
(718) 283-6000
Mailing address
836 40TH STREET APT 1L, BROOKLYN, NY 11232
(518) 364-8571
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
P99679
NY
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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