Healthcare Provider Details

I. General information

NPI: 1013912989
Provider Name (Legal Business Name): MA. LOURDES DE ASIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS ROAD AMBULATORY CARE PAVILION, 3RD FLOOR
VALHALLA NY
10595
US

IV. Provider business mailing address

100 WOODS ROAD AMBULATORY CARE PAVILION, 3RD FLOOR
VALHALLA NY
10595
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7518
  • Fax: 914-493-8130
Mailing address:
  • Phone: 914-493-7518
  • Fax: 914-493-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number203287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: