=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164814257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHOKAN NATURAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2015
-----------------------------------------------------
Last Update Date | 02/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 DANBURY RD
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06877-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-794-6331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 HOLLOW DR
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-794-6331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ASHLEY RUSSELL
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 203-794-6331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 000492
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------