Provider Demographics
NPI:1992753461
Name:ALFAMED PHYSICIAN PC
Entity type:Organization
Organization Name:ALFAMED PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OBIORA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANYOKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-868-4553
Mailing Address - Street 1:2008 SEAGIRT BLVD
Mailing Address - Street 2:ALFAMED PHYSICIAN PC
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-868-4553
Mailing Address - Fax:718-868-4831
Practice Address - Street 1:20 08 SEAGIRT BLVD
Practice Address - Street 2:ALFAMED PHYSICIAN PC
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-868-4553
Practice Address - Fax:718-868-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
134914OtherAETNA
05653Medicare ID - Type Unspecified
X87337Medicare UPIN