Provider Demographics
NPI:1063700367
Name:ASTORIA ADVANCED AND INTEGRATIVE MEDICINE PC
Entity type:Organization
Organization Name:ASTORIA ADVANCED AND INTEGRATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CREDENTIALING & COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOELPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-724-8398
Mailing Address - Street 1:3080 21ST ST
Mailing Address - Street 2:2ND FLOOR MEDICAL CENTER
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4242
Mailing Address - Country:US
Mailing Address - Phone:718-873-9550
Mailing Address - Fax:718-228-4591
Practice Address - Street 1:3080 21ST ST
Practice Address - Street 2:2ND FLOOR MEDICAL CENTER
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4242
Practice Address - Country:US
Practice Address - Phone:718-873-9550
Practice Address - Fax:718-228-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty