=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629254412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIMC FACULTY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2008
-----------------------------------------------------
Last Update Date | 06/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 E 17TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-523-5215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 AIRPORT EXECUTIVE PARK
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-5288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | ALEXANDER ASKANAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-523-5215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------