Basic Information
| Provider Information | |||||||||
| NPI: | 1881652907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSTRANDER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855543119 | ||||||||
| FaxNumber: | 5855543323 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 STATE ROUTE 245 | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145449604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855543119 | ||||||||
| FaxNumber: | 5855543323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 160360 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 160360 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00948072 | 05 | NY | MEDICAID | MD1625 | 01 | NY | PREFFERED CARE | OTHER | 1234 | 01 | NY | BC/BS | OTHER |