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General NPI Number Information
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NPI Number | 1588896708
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Entity Type | Individual
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Provider Name | JUSTIN ANTHONY CLASSIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 16303 HORACE HARDING EXPY 4TH FLOOR
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-1454
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Country | US
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Telephone | 866-670-6824
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Fax | 718-670-2249
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Provider Business Mailing Address
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Address Line | 5645 MAIN ST 4TH FLOOR SOUTH
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City | FLUSHING
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State | NY
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Zip | 11355-5045
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Country | US
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Telephone | 866-670-6824
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Fax | 718-670-2249
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 093034
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 255812
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License Number State | NY
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