=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245736651
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IFEYINWA ASONYE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2018
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 FORT WASHINGTON AVE INTERNAL MEDICINE RESIDENCY OFFICE, FLOOR 6, CENTER 12
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-6262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 331 NEWMAN SPRINGS RD STE 220
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-807-0877
-----------------------------------------------------
Fax | 201-751-1680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 25MA12395100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 312590
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------