MEDICARE: DR. BENEDICTO ASA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	137926	NY

General Provider Information

NPI Number	:	1114049582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENEDICTO ASA M.D.

Provider Business Mailing Address
First Line	:	62 CARWALL AVE.,
Second Line	:
City	:	MT. VERNON
State	:	NY
Zip	:	10552
Country	:	US
Telephone Number	:	914-664-1757
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 MORNINGSIDE AVE.,
Second Line	:	HARLEM HEALTH CENTER
City	:	NEW YORK
State	:	NY
Zip	:	10027-6017
Country	:	US
Telephone Number	:	212-923-2525
Fax Number	:	212-866-3593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/07/2010

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