Provider Demographics
NPI:1215936299
Name:STROBECK, JOHN EDWARD (MD, PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:STROBECK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 RICHMOND RD STE B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2583
Mailing Address - Country:US
Mailing Address - Phone:718-374-5223
Mailing Address - Fax:855-420-5931
Practice Address - Street 1:2052 RICHMOND RD STE B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2583
Practice Address - Country:US
Practice Address - Phone:718-374-5223
Practice Address - Fax:855-420-5931
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1306831207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY130683-1OtherNY STATE MEDICAL LICENSE
NY130683-1OtherNY STATE MEDICAL LICENSE
NY02743653Medicaid
NY02743653Medicaid
NY130683-1OtherNY STATE MEDICAL LICENSE
NYWEZ411Medicare PIN
NY300011Medicare PIN
NYWEN291Medicare PIN