Provider Demographics
NPI:1588896708
Name:CLASSIE, JUSTIN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:CLASSIE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:4TH FLOOR SOUTH
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:866-670-6824
Mailing Address - Fax:718-670-2249
Practice Address - Street 1:16303 HORACE HARDING EXPY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1454
Practice Address - Country:US
Practice Address - Phone:866-670-6824
Practice Address - Fax:718-670-2249
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2022-11-16
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Provider Licenses
StateLicense IDTaxonomies
OH093034207QS0010X
NY255812207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400087729Medicare PIN