Healthcare Provider Details

I. General information

NPI: 1962627562
Provider Name (Legal Business Name): REBECCA L ASCHOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 JERSEY AVE
PORT JERVIS NY
12771-2436
US

IV. Provider business mailing address

15 JERSEY AVE
PORT JERVIS NY
12771-2436
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-8780
  • Fax: 845-692-3439
Mailing address:
  • Phone: 845-692-8780
  • Fax: 845-692-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number447811-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: