Basic Information
| Provider Information | |||||||||
| NPI: | 1215936299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STROBECK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 831 LITTLE BRITAIN RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125535518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454461100 | ||||||||
| FaxNumber: | 8455624902 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 LITTLE BRITAIN RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125535518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454461100 | ||||||||
| FaxNumber: | 8455624902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 1306831 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | MA031767 | 01 | NJ | NJ STATE MEDICAL LICENSE | OTHER | 130683-1 | 01 | NY | NY STATE MEDICAL LICENSE | OTHER | 02743653 | 05 | NY | MEDICAID |