Provider Demographics
NPI:1952750036
Name:PASSIK, ASHLEY (MMS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PASSIK
Suffix:
Gender:F
Credentials:MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 77TH ST
Mailing Address - Street 2:12F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2303
Mailing Address - Country:US
Mailing Address - Phone:203-627-0722
Mailing Address - Fax:
Practice Address - Street 1:400 E 77TH ST
Practice Address - Street 2:12F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2303
Practice Address - Country:US
Practice Address - Phone:203-627-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3580129252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12151988OtherINDIVIDUAL