Provider Demographics
NPI:1003309840
Name:ANCHOR MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:ANCHOR MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUTOYIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-380-7331
Mailing Address - Street 1:P.O. BOX 110808
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411
Mailing Address - Country:US
Mailing Address - Phone:929-301-4429
Mailing Address - Fax:347-515-6969
Practice Address - Street 1:7838 PARSONS BLVD FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:929-301-4429
Practice Address - Fax:347-515-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281010261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1396092318Medicaid