Provider Demographics
NPI:1306592068
Name:BAJANA, ALBERTO I
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:BAJANA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WAKEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4210
Mailing Address - Country:US
Mailing Address - Phone:914-484-7460
Mailing Address - Fax:
Practice Address - Street 1:11 WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4210
Practice Address - Country:US
Practice Address - Phone:914-484-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36879171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator