Provider Demographics
NPI:1093754228
Name:DE ASIS, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:DE ASIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 3678
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0037
Mailing Address - Country:US
Mailing Address - Phone:314-590-3000
Mailing Address - Fax:
Practice Address - Street 1:CMR 415
Practice Address - Street 2:BLDG 507
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:09114
Practice Address - Country:US
Practice Address - Phone:314-590-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2126492084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG99261Medicare UPIN
NY73M431Medicare PIN