Provider Demographics
NPI:1851899363
Name:ASTRUP, JASON D
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:ASTRUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 DENVER RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3625
Mailing Address - Country:US
Mailing Address - Phone:516-395-0293
Mailing Address - Fax:
Practice Address - Street 1:1832 DENVER RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3625
Practice Address - Country:US
Practice Address - Phone:516-395-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY856556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist