| Doctor Name: | DR. JUN MICHAEL MITSUMOTO |
| NPI Number: | 1255612826 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., M.P.H. |
| License Number: | |
| Business Practice Address: | 2 Perlman Dr Hudson River Healthcare, Inc. Spring Valley, NY - 109775245 |
| Business Phone Number: | 8455739860 |
| Business Fax Number: | 8455739865 |
| Mailing Address: | 1037 Main St, Hudson River Healthcare, Inc. PEEKSKILL |
| State: | NY |
| Postal Code: | 105662913 |
| Phone Number: | 9147348800 |
| Fax Number: | 9147348808 |
| NPI Enumeration Date: | 09/08/2011 |
| NPI Last Update Date: | 07/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |