MEDICARE: ASTRA HEALTH CENTER OF BELLEVILLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	2083X0100X	Occupational Medicine Physician
4	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1881002301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTRA HEALTH CENTER OF BELLEVILLE, LLC

Provider Business Mailing Address
First Line	:	50 WASHINGTON AVE
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-2930
Country	:	US
Telephone Number	:	908-760-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 WASHINGTON AVE
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-2930
Country	:	US
Telephone Number	:	908-760-8888
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. ANTHONY RUSSO
Credential	:
Telephone Number	:	908-760-8888

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	10/13/2015

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