Provider Demographics
NPI:1730988387
Name:ASCEND AUTISM MEDICAL DIAGNOSTIC SERVICES PLLC
Entity type:Organization
Organization Name:ASCEND AUTISM MEDICAL DIAGNOSTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRONFORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-233-9907
Mailing Address - Street 1:22 SAW MILL RIVER RD STE 308
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:877-323-8668
Mailing Address - Fax:203-547-6280
Practice Address - Street 1:15 KETCHUM ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5959
Practice Address - Country:US
Practice Address - Phone:877-323-8668
Practice Address - Fax:203-547-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty