Provider Demographics
NPI:1174840540
Name:ALEPH MEDICAL GROUP
Entity Type:Organization
Organization Name:ALEPH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-934-2211
Mailing Address - Street 1:2995 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8387
Mailing Address - Country:US
Mailing Address - Phone:718-934-2211
Mailing Address - Fax:718-934-2225
Practice Address - Street 1:2995 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8387
Practice Address - Country:US
Practice Address - Phone:718-934-2211
Practice Address - Fax:718-934-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71Z031Medicare PIN