Provider Demographics
NPI:1952334625
Name:DUCENA, ERNST (MD)
Entity Type:Individual
Prefix:
First Name:ERNST
Middle Name:
Last Name:DUCENA
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 1:495 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2202
Mailing Address - Country:US
Mailing Address - Phone:516-526-2615
Mailing Address - Fax:
Practice Address - Street 1:253 E 142ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5906
Practice Address - Country:US
Practice Address - Phone:718-676-1651
Practice Address - Fax:718-676-1653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY210429OtherNYS LICENSE