Basic Information
| Provider Information | |||||||||
| NPI: | 1316298110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AJASIN | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | RN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3216 EASTCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104692703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462395099 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2054 TILLOTSON AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104751560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2012 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 659759 | NY | N | Nursing Service Providers | Registered Nurse | 363L00000X | 343890 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.