Healthcare Provider Details

I. General information

NPI: 1588738835
Provider Name (Legal Business Name): HELEN DE ASIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BROADWAY
HAVERSTRAW NY
10927-1147
US

IV. Provider business mailing address

14 LEEWARD DR
HAVERSTRAW NY
10927-2105
US

V. Phone/Fax

Practice location:
  • Phone: 845-429-9501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number159990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: