Provider Demographics
NPI:1114049582
Name:ASA, BENEDICTO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICTO
Middle Name:
Last Name:ASA
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 1:62 CARWALL AVE.,
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552
Mailing Address - Country:US
Mailing Address - Phone:914-664-1757
Mailing Address - Fax:
Practice Address - Street 1:133 MORNINGSIDE AVE.,
Practice Address - Street 2:HARLEM HEALTH CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6017
Practice Address - Country:US
Practice Address - Phone:212-923-2525
Practice Address - Fax:212-866-3593
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine