Provider Demographics
NPI:1619125440
Name:ALBERT NOSRATI, MD. PC
Entity Type:Organization
Organization Name:ALBERT NOSRATI, MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSRATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-328-9797
Mailing Address - Street 1:2035 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1661
Mailing Address - Country:US
Mailing Address - Phone:516-328-9797
Mailing Address - Fax:
Practice Address - Street 1:2035 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1661
Practice Address - Country:US
Practice Address - Phone:516-328-9797
Practice Address - Fax:516-352-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190504207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01410493Medicaid
NYG100059725Medicare PIN
NY01410493Medicaid