Provider Demographics
NPI:1285629030
Name:ALCASABAS, AURENE DELA CRUZ (MD)
Entity Type:Individual
Prefix:
First Name:AURENE
Middle Name:DELA CRUZ
Last Name:ALCASABAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2825
Mailing Address - Country:US
Mailing Address - Phone:631-475-7370
Mailing Address - Fax:631-475-7375
Practice Address - Street 1:45 ROSE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2825
Practice Address - Country:US
Practice Address - Phone:631-475-7370
Practice Address - Fax:631-475-7375
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16437OtherVYTRA
NYCP455OtherOXFORD
NY16437OtherVYTRA
NYCP455OtherOXFORD