Basic Information
| Provider Information | |||||||||
| NPI: | 1457388951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOIKE | ||||||||
| FirstName: | HIDEO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 GRASSLANDS ROAD | ||||||||
| Address2: | MACY PAVILION, 2ND FLOOR | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937692 | ||||||||
| FaxNumber: | 9144937927 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 GRASSLANDS ROAD | ||||||||
| Address2: | MACY PAVILION, 2ND FLOOR | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937692 | ||||||||
| FaxNumber: | 9144937927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 226663 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 02426680 | 05 | NY | MEDICAID |