Provider Demographics
NPI:1356679823
Name:JOHN, ASHA (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:ALIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 ESQUIRE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-499-2460
Mailing Address - Fax:845-499-2462
Practice Address - Street 1:10 ESQUIRE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-499-2460
Practice Address - Fax:845-499-2462
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08590400207R00000X
NY2596431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213307YD9XMedicare PIN