Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 203287 | NY |
N | 207K00000X | Allergist & Immunologist | 60591 | NJ |
NPI | 1013912989 |
---|---|
Provider Name | Ma. Lourdes De Asis |
First Address | West Nyack, NY 10994-2212 |
Second Address | West Nyack, NY 10994-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |