Healthcare Provider Details

I. General information

NPI: 1770513996
Provider Name (Legal Business Name): JANETTE DIANA ASARO PENA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BUNDY HILL RD
HOLMES NY
12531-5300
US

IV. Provider business mailing address

89 BUNDY HILL RD
HOLMES NY
12531-5300
US

V. Phone/Fax

Practice location:
  • Phone: 917-574-6396
  • Fax: 914-885-1091
Mailing address:
  • Phone: 917-574-6396
  • Fax: 914-885-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: