DR. STEPHEN TAKEO NISHIYAMA (NPI# 1710978622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710978622 |
| Entity Type | Individual |
| Full Name | DR. STEPHEN TAKEO NISHIYAMA |
| Credential | MD |
| Practice Address |
40 Second Ave Ste 400 Waltham MA 02451 |
| Mailing Address |
Po Box 9142 Mass General Physician Organization Charlestown MA 02129-9142 |
| Practice Telephone | 7814874340 |
| Practice Fax Number | 7814874341 |
| Mailing Telephone | 7814874340 |
| Mailing Fax Number | 7814874341 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2013-01-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 81412 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 3141683 | 05 | |
| MA | BCBS MA | J31669 | 01 |
| MA | TUFTS HEALTH PLAN | 081412 | 01 |
| Street Address |
40 SECOND AVE STE 400 |
| City | WALTHAM |
| State | MA |
| Zip Code | 02451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396936498 | Devasena Balasubramaniam | Internal Medicine | 40 Second Ave, Mass General West, Waltham, MA 02451 | 2007-08-05 |
| 1932257698 | Theresa A Schnorr | Nurse Practitioner | 40 Second Ave, Suite 340, Waltham, MA 02451 | 2007-01-08 |
| 1043382393 | Donna Ann Stampone | Nurse Practitioner | 40 Second Ave, Waltham, MA 02451 | 2006-11-14 |
| 1831276310 | Judith A Manzer | Nurse Anesthetist, Certified Registered | 40 Second Ave, Suite 200, Waltham, MA 02451 | 2006-11-01 |
| 1821194879 | Daniel P. Gaposchkin | Internal Medicine | 40 Second Ave, Suite #400, Waltham, MA 02154 | 2006-09-16 |
| 1083674352 | Charles A Kelly | Anesthesiology | 40 Second Ave, Waltham, MA 02451 | 2006-03-23 |
| 1619942661 | Arthur King-fan Tong | Dermatology | 40 Second Ave, Mass General West, Waltham, MA 02451 | 2006-02-22 |
| 1417921149 | Aubrey J Katz | Pediatrics | 40 Second Ave, Mass General West, Waltham, MA 02451 | 2006-02-17 |
| 1467443259 | Jeffrey A Biller | Pediatrics | 40 Second Ave, Ste 340 Mass General West, Waltham, MA 02451 | 2005-11-02 |
| 1518958131 | Christina Gelev | Internal Medicine | 40 Second Ave, Suite 400 Mass General Medical Group, Waltham, MA 02451-1132 | 2005-11-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719190 | Haeun Yang | Behavior Technician | 303 Wyman Street Suite 354, 344, 345, Waltham, MA 02451 | 2019-09-16 |
| 1982252599 | Sinclair Fashaw-braxton | Behavior Technician | 303 Wyman Street, Suite 354, 344, 345, Waltham, MA 02451 | 2019-08-27 |
| 1245715879 | Annie F Friedman | Social Worker | Extended Stay America, 32 4the Avenue, Waltham, MA 02451 | 2018-09-28 |
| 1760964118 | Elizabeth Boardman Harris | Social Worker | 60 Hickory Drive 4th Floor, Waltham, MA 02451 | 2018-09-02 |
| 1760960959 | Patriot Urgent Care Professionals, PC | General Practice | 1030 Main Street, Unit 2, Waltham, MA 02451 | 2018-07-31 |
| 1962998013 | Leighann Teresa Healy | Behavior Technician | 303 Wyman Suite 300, Waltham, MA 02451 | 2018-07-02 |
| 1194234492 | Bruna Rossi Hoffman | Dentist | 12 Grant Place, Apt 1, Waltham, MA 02451 | 2017-09-29 |
| 1265959159 | Matthew C Page-shelton | Counselor | 2208 Stearns Hill Road, Waltham, MA 02451 | 2017-08-23 |
| 1306380837 | Sherri Lynn Duquette | Behavior Technician | 1430 Main Street, Waltham, MA 02451 | 2016-12-19 |
| 1649628728 | Keren Matveev | Family Medicine | 75 Third Avenue, First Floor, Waltham, MA 02451 | 2016-05-30 |
| Find all providers in zip 02451 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295861961 | Sarah Pritchett Zimmerman | Pediatrics | 40 2nd Ave Ste 400, Waltham, MA 02451-1137 | 2007-02-26 |
| 1194868596 | Myron B Peterson | Pediatrics | Cato Ltd., 1100 Winter Street, Waltham, MA 02451 | 2007-02-15 |
| 1164576237 | Cynthia Sacco | Pediatrics | 245 Winter St, Waltham, MA 02451-8777 | 2007-01-23 |
| 1386688828 | James I Goldston | Pediatrics | 42 Weston St Ste 2a, Waltham, MA 02453-7756 | 2006-06-15 |
| 1518923259 | David Y Dominguez | Pediatrics | 465 Waverley Oaks Rd Ste 100, Waltham, MA 02452-8484 | 2006-04-21 |
| 1558345835 | Alice Whittier Newton | Pediatrics | 465 Waverley Oaks Rd, Suite 100, Waltham, MA 02452-8438 | 2005-12-01 |
| 1053393470 | Catherine M Nowak | Pediatrics | Children's Hospital Waltham - Dept of Medicine, 9 Hope Avenue, Waltham, MA 02453-2765 | 2005-11-20 |
| 1104817717 | Robert D Fusunyan | Pediatrics | 40 2nd Avenue, Suite 340, Waltham, MA 02451-1132 | 2005-11-02 |
| 1972642494 | Heena Banker | Pediatrics | 20 Hope Ave, Suite G14, Waltham, MA 02453-2721 | 2007-02-05 |
| 1922191329 | George Dallos | Pediatrics | 20 Hope Ave, Suite G06, Waltham, MA 02453 | 2006-09-30 |
| Find all providers in WALTHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.