Ashley Decrescenzo
Individual provider Active NPI Specialist · Brightwaters, NY
NPI 1659616290 · NPPES record last updated Dec 9, 2012
Key facts
- NPI
- 1659616290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 688222121 (NY)
- Practice address
- 400 Pine Dr
Brightwaters, NY 11718-1810 - Phone
- (631) 741-2818
- NPI assigned
- Dec 9, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 397531101 | NY | MD | Specialist |
| 397636101 | NY | MD | Specialist |
| 688222121 | NY | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 688222121 | NY | Yes |
| Specialist | 174400000X | 397531101 | NY | |
| Specialist | 174400000X | 397636101 | NY |
Addresses
Primary practice location
400 Pine Dr
Brightwaters, NY 11718-1810
Mailing address
400 Pine Dr
Brightwaters, NY 11718-1810
Phone (631) 741-2818
Other providers in Brightwaters, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.