Provider Demographics
NPI:1295045029
Name:MICHAEL J. ALBOM MD P C
Entity Type:Organization
Organization Name:MICHAEL J. ALBOM MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALBOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-2121
Mailing Address - Street 1:33 E. 70TH ST
Mailing Address - Street 2:1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4985
Mailing Address - Country:US
Mailing Address - Phone:212-517-2121
Mailing Address - Fax:212-517-5601
Practice Address - Street 1:33 E 70TH ST
Practice Address - Street 2:1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4985
Practice Address - Country:US
Practice Address - Phone:212-517-2121
Practice Address - Fax:212-517-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79020Medicare UPIN
NY712321Medicare PIN