Individual
ANSELMO DEASIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7433 STATE ROUTE 54, BATH, NY 14981
(607) 776-9198
(607) 776-9199
Mailing address
111 E 14TH ST, ELMIRA HEIGHTS, NY 14903-1303
(607) 734-9539
(607) 734-6293
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
184984
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01267674
—
NY
Enumeration date
07/10/2006
Last updated
10/23/2008
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