Healthcare Provider Details

I. General information

NPI: 1841528080
Provider Name (Legal Business Name): ASTRA MD P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BLOOMFIELD AVE
NEWARK NJ
07107-1386
US

IV. Provider business mailing address

550 BLOOMFIELD AVE
NEWARK NJ
07107-1386
US

V. Phone/Fax

Practice location:
  • Phone: 973-483-1500
  • Fax:
Mailing address:
  • Phone: 973-483-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07003100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA07840500
License Number StateNJ

VIII. Authorized Official

Name: DR. NATASHA FUKSINA
Title or Position: PRESIDENT
Credential:
Phone: 973-483-1500