Provider Demographics
NPI:1245603398
Name:ALFORD A SMITH MD PC
Entity Type:Organization
Organization Name:ALFORD A SMITH MD PC
Other - Org Name:FLATBUSH FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFORD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-763-6721
Mailing Address - Street 1:PO BOX 150379
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-0379
Mailing Address - Country:US
Mailing Address - Phone:917-763-6721
Mailing Address - Fax:347-561-6170
Practice Address - Street 1:765 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4203
Practice Address - Country:US
Practice Address - Phone:718-282-1570
Practice Address - Fax:347-561-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832339Medicaid
NYA61223Medicare UPIN