Provider Demographics
NPI:1285863951
Name:ASENCIO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ASENCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 E 174TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-6904
Mailing Address - Country:US
Mailing Address - Phone:718-299-2416
Mailing Address - Fax:718-299-5176
Practice Address - Street 1:154 E 174TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6904
Practice Address - Country:US
Practice Address - Phone:718-299-2416
Practice Address - Fax:718-299-5176
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist