MEDICARE: MR. JOHN ASTRAB MS PT OCS CSCS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	023964	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0013701	OTHER		ORTHONET AETNA HMO
2	0222701	OTHER		ORTHONET CIGNA HMO
3	0222701	OTHER		ORTHONET USFH
4	133542448	OTHER		PHCS
5	5466920	OTHER		CIGNA PPO
6	133542448-17	OTHER		FIRST HEALTH/ICM
7	3104338	OTHER		AETNA HMO
8	133542448	OTHER		POMCO
9	7473440	OTHER		AETNA PPO
10	QP3601	OTHER	NY	EMPIRE BC/BS
11	109230200	OTHER		US DEPT OF LABOR
12	0222701	OTHER		ORTHONET HEALTHNET
13	133542448-02	OTHER		LOCAL 1199

General Provider Information

NPI Number	:	1942205158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ASTRAB MS PT OCS CSCS

Provider Business Mailing Address
First Line	:	1760 SOUTH ROUTE 9
Second Line	:
City	:	GARRISON
State	:	NY
Zip	:	10524-3852
Country	:	US
Telephone Number	:	845-424-6422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 SOUTH ROUTE 9
Second Line	:
City	:	GARRISON
State	:	NY
Zip	:	10524-3852
Country	:	US
Telephone Number	:	845-424-6422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/09/2014

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