Provider Demographics
NPI:1255312930
Name:21ST CENTURY MEDICAL PC
Entity Type:Organization
Organization Name:21ST CENTURY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOYTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD DO
Authorized Official - Phone:718-743-3100
Mailing Address - Street 1:305 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6826
Mailing Address - Country:US
Mailing Address - Phone:718-743-3100
Mailing Address - Fax:718-368-9044
Practice Address - Street 1:305 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6826
Practice Address - Country:US
Practice Address - Phone:718-743-3100
Practice Address - Fax:718-368-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02727677Medicaid
NYG90474Medicare UPIN