Healthcare Provider Details

I. General information

NPI: 1346675725
Provider Name (Legal Business Name): ASTRA HEALTH CENTER OF LYONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LYONS MALL
BASKING RIDGE NJ
07920-1928
US

IV. Provider business mailing address

18 LYONS MALL
BASKING RIDGE NJ
07920-1928
US

V. Phone/Fax

Practice location:
  • Phone: 908-760-8888
  • Fax:
Mailing address:
  • Phone: 908-760-8888
  • Fax: 908-340-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY RUSSO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 908-760-8888