Provider Demographics
NPI:1336109842
Name:OBIAKOR MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:OBIAKOR MEDICAL PRACTICE PLLC
Other - Org Name:AFAM MULTISPECIALTY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-688-8000
Mailing Address - Street 1:PO BOX 250141
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-0141
Mailing Address - Country:US
Mailing Address - Phone:718-688-8000
Mailing Address - Fax:718-385-5104
Practice Address - Street 1:5205 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3513
Practice Address - Country:US
Practice Address - Phone:718-688-8000
Practice Address - Fax:718-385-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0256831Medicaid
NYW31201Medicare PIN