1730988387 NPI number — ASCEND AUTISM MEDICAL DIAGNOSTIC SERVICES PLLC

Table of content: (NPI 1730988387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730988387 NPI number — ASCEND AUTISM MEDICAL DIAGNOSTIC SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCEND AUTISM MEDICAL DIAGNOSTIC SERVICES PLLC
Provider Last Name:
Provider First Name:
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Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1730988387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 SAW MILL RIVER RD STE 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10532-1533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-323-8668
Provider Business Mailing Address Fax Number:
203-547-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 KETCHUM ST LOWR LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880-5959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-323-8668
Provider Business Practice Location Address Fax Number:
203-547-6280
Provider Enumeration Date:
03/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
KRONFORST
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
617-233-9907

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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