Provider Demographics
NPI:1972694677
Name:OSTRAGER, BRET (DO)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:
Last Name:OSTRAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 GRAND AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-623-4800
Mailing Address - Fax:516-623-8845
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:STE 208
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-623-4800
Practice Address - Fax:516-623-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01541946Medicaid
62J711Medicare ID - Type Unspecified
NY01541946Medicaid