Healthcare Provider Details

I. General information

NPI: 1285629030
Provider Name (Legal Business Name): AURENE DELA CRUZ ALCASABAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROSE AVE
PATCHOGUE NY
11772-2825
US

IV. Provider business mailing address

45 ROSE AVE
PATCHOGUE NY
11772-2825
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-7370
  • Fax: 631-475-7375
Mailing address:
  • Phone: 631-475-7370
  • Fax: 631-475-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number174029
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier16437
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVYTRA
# 2
IdentifierCP455
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: