Provider Demographics
NPI:1881930444
Name:ASTRABIO, INC
Entity type:Organization
Organization Name:ASTRABIO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLOWMENIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-200-9974
Mailing Address - Street 1:95 SEAVIEW BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4619
Mailing Address - Country:US
Mailing Address - Phone:516-200-9974
Mailing Address - Fax:516-200-9980
Practice Address - Street 1:95 SEAVIEW BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4619
Practice Address - Country:US
Practice Address - Phone:516-200-9974
Practice Address - Fax:516-200-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPFI 2148291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300096932Medicare PIN