Healthcare Provider Details

I. General information

NPI: 1851316574
Provider Name (Legal Business Name): ALEX B. STRASSBURG, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

IV. Provider business mailing address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 814-723-4973
  • Fax: 814-726-2712
Mailing address:
  • Phone: 814-723-4973
  • Fax: 814-726-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD071700L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD071700L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number247087
License Number StateNY

VIII. Authorized Official

Name: ALEX B STRASSBURG
Title or Position: OWNER
Credential: MD
Phone: 814-723-4973