Provider Demographics
NPI:1386391266
Name:ALPHA MEDICAL WAVE, LLC
Entity type:Organization
Organization Name:ALPHA MEDICAL WAVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-899-2877
Mailing Address - Street 1:1197 HILLSIDE AVE # A26
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3539
Mailing Address - Country:US
Mailing Address - Phone:712-899-2877
Mailing Address - Fax:
Practice Address - Street 1:2290 10TH AVE N STE 104
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6609
Practice Address - Country:US
Practice Address - Phone:561-420-0012
Practice Address - Fax:561-828-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTSTITUTE OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty