Provider Demographics
NPI:1669664686
Name:ASHA DUA PHYSICIAN PC
Entity Type:Organization
Organization Name:ASHA DUA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL MEDICINE AND REHAB
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:718-251-4878
Mailing Address - Street 1:6 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1112
Mailing Address - Country:US
Mailing Address - Phone:718-251-4878
Mailing Address - Fax:718-968-0573
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:STE B10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:718-251-4878
Practice Address - Fax:718-968-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215740261Q00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03196967Medicaid
NY02084646Medicaid
NY02084646Medicaid
NY5467280001Medicare NSC
NYWZXRZ1Medicare PIN
NY70Z641Medicare PIN