Provider Demographics
NPI:1427467240
Name:BOUSSERHANE, ASMAA
Entity type:Individual
Prefix:
First Name:ASMAA
Middle Name:
Last Name:BOUSSERHANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASMAA
Other - Middle Name:
Other - Last Name:BOUSSERHANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1825 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2301
Mailing Address - Country:US
Mailing Address - Phone:718-907-2000
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5874
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC2000X
NY289790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282NC2000XHospitalsGeneral Acute Care HospitalChildren