Healthcare Provider Details

I. General information

NPI: 1912278540
Provider Name (Legal Business Name): ASENA BAHCE-ALTUNTAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 04/06/2022
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 PROSPECT AVE STE 204
HACKENSACK NJ
07601-2570
US

IV. Provider business mailing address

385 PROSPECT AVE STE 204
HACKENSACK NJ
07601-2570
US

V. Phone/Fax

Practice location:
  • Phone: 519-969-1405
  • Fax:
Mailing address:
  • Phone: 519-969-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number278256
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA09038700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: