Provider Demographics
NPI:1154613214
Name:BAKIR MOHAMMED ALTAI
Entity type:Organization
Organization Name:BAKIR MOHAMMED ALTAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT ALTAI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-453-8900
Mailing Address - Street 1:PO BOX 4115
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4115
Mailing Address - Country:US
Mailing Address - Phone:201-453-8900
Mailing Address - Fax:201-453-8903
Practice Address - Street 1:606 W 146TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4305
Practice Address - Country:US
Practice Address - Phone:212-444-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY74348492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty