1164503207 NPI number — DR. ALEKSEY TEN MD

Table of content: DR. ALEKSEY TEN MD (NPI 1164503207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164503207 NPI number — DR. ALEKSEY TEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEN
Provider First Name:
ALEKSEY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164503207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79-01 BROADWAY
Provider Second Line Business Mailing Address:
MANAGED CARE, D1-01
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-334-1921
Provider Business Mailing Address Fax Number:
718-334-3432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82-68 164TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-883-3225
Provider Business Practice Location Address Fax Number:
718-883-6193
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  241780 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00246075 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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