Basic Information
Provider Information | |||||||||
NPI: | 1619168689 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STRASSBURG | ||||||||
FirstName: | ALEX | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STRASSBURG | ||||||||
OtherFirstName: | ALEXIS | ||||||||
OtherMiddleName: | B | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 2 W CRESCENT PARK | ||||||||
Address2: |   | ||||||||
City: | WARREN | ||||||||
State: | PA | ||||||||
PostalCode: | 163652111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8147234973 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2 W CRESCENT PARK | ||||||||
Address2: |   | ||||||||
City: | WARREN | ||||||||
State: | PA | ||||||||
PostalCode: | 163652111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8147234973 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/06/2007 | ||||||||
LastUpdateDate: | 05/09/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD071700L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RS0012X | MD071700L | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207R00000X | 247087 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.