1952334625 NPI number — ERNST DUCENA MD

Table of content: ERNST DUCENA MD (NPI 1952334625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952334625 NPI number — ERNST DUCENA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUCENA
Provider First Name:
ERNST
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952334625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 EMERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BALDWIN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11510-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-526-2615
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
253 E 142ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-676-1651
Provider Business Practice Location Address Fax Number:
718-676-1653
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  210429 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 210429 . This is a "NYS LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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