Provider Demographics
NPI:1275628182
Name:ALTAI, BAKIR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAKIR
Middle Name:
Last Name:ALTAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 7TH AVE
Mailing Address - Street 2:PMB # 202
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4194
Mailing Address - Country:US
Mailing Address - Phone:212-444-2209
Mailing Address - Fax:
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6177
Practice Address - Country:US
Practice Address - Phone:212-444-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053891002086S0129X
NY17378712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2318407Medicaid
NJ621816OtherPTAN
NJ621816Medicare ID - Type Unspecified
NJE78054Medicare UPIN