Provider Demographics
NPI:1093856056
Name:ASTRAL PHYSICIANS PC
Entity Type:Organization
Organization Name:ASTRAL PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-216-4937
Mailing Address - Street 1:1251 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4612
Mailing Address - Country:US
Mailing Address - Phone:610-216-4937
Mailing Address - Fax:215-447-5169
Practice Address - Street 1:1251 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-4612
Practice Address - Country:US
Practice Address - Phone:610-216-4937
Practice Address - Fax:215-447-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007932L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5542028OtherAETNA
PA025393WCNOtherMEDICARE GROUP MEMBER PRO
PA385035OtherBLUE SHIELD
PA10938310OtherCAQH
PA385035OtherBLUE SHIELD
PA=========OtherEIN
PA109509Medicare PIN