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General NPI Number Information
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NPI Number | 1881930444
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Entity Type | Organization
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Legal Business Name | ASTRABIO, INC
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Dates
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Enumeration Date | 12/28/2012
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 95 SEAVIEW BLVD SUITE 204
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4619
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Country | US
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Telephone | 516-200-9974
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Fax | 516-200-9980
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Provider Business Mailing Address
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Address Line | 95 SEAVIEW BLVD SUITE 204
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4619
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Country | US
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Telephone | 516-200-9974
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Fax | 516-200-9980
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLOWMENIA I COSTA
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Credential |
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Telephone | 516-200-9974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | PFI 2148
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License Number State | NY
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