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DR. LEO RYO OTAKE M.D. PH.D NPI 1770761025


NPI Information

NPI: 1770761025
Provider Name: DR. LEO RYO OTAKE, M.D., PH.D,
Classification: Plastic Surgery - 208200000X
Entity Type: Individual

PECOS Registration: Yes

Address:
722 POST RD
DARIEN, CT
ZIP 06820
Phone: (203) 656-9999
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DR. Leo Ryo Otake, M.D., PH.D, is a plastic surgery in Darien, CT with 22 years of experience. The provider is a plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. DR. Leo Ryo Otake, M.D., PH.D, NPI is 1770761025. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: YALE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2002

The provider's business location address is:

722 POST RD
DARIEN, CT
ZIP 06820
Phone: (203) 656-9999

The NPI 1770761025 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/7/2008 and was last updated on 5/14/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208200000XPlastic Surgery246657NEW YORKNo
2208200000XPlastic Surgery046053CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D400026606OTHERCONNECTICUTINDIVIDUAL MEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.