Individual
ASTHA MUTTREJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4 SMITH HAVEN MALL STE 202, LAKE GROVE, NY 11755-1219
(631) 444-6250
(631) 444-6665
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-8036
(631) 444-2198
(631) 444-7525
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
301905
NY
2083P0901X
Public Health & General Preventive Medicine Physician
301905
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
05/06/2015
Last updated
11/20/2025
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