Provider Demographics
NPI:1013291384
Name:TRASTELIS, BESSIE
Entity type:Individual
Prefix:MRS
First Name:BESSIE
Middle Name:
Last Name:TRASTELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3650
Mailing Address - Country:US
Mailing Address - Phone:516-791-9555
Mailing Address - Fax:516-791-9555
Practice Address - Street 1:443 HUNGRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3650
Practice Address - Country:US
Practice Address - Phone:516-791-9555
Practice Address - Fax:516-791-9555
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004860-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004860-1OtherCOTA