Provider Demographics
NPI:1952699084
Name:ASTAFAN, AMBER R (PT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:R
Last Name:ASTAFAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 NUMBER FOUR RD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-3309
Mailing Address - Country:US
Mailing Address - Phone:315-377-4114
Mailing Address - Fax:315-377-4115
Practice Address - Street 1:6006 NUMBER FOUR RD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-3309
Practice Address - Country:US
Practice Address - Phone:315-377-4114
Practice Address - Fax:315-377-4115
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033815225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400096552Medicare PIN