Provider Demographics
NPI:1629149927
Name:ALBRIGHT MEDICAL OFFICES, PC
Entity Type:Organization
Organization Name:ALBRIGHT MEDICAL OFFICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ONYEMACHI
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:AJAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-454-1466
Mailing Address - Street 1:111-02 FARMERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2328
Mailing Address - Country:US
Mailing Address - Phone:718-454-1466
Mailing Address - Fax:718-454-1467
Practice Address - Street 1:111-02 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2328
Practice Address - Country:US
Practice Address - Phone:718-454-1466
Practice Address - Fax:718-454-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02553666Medicaid
NY4435EKMedicare ID - Type Unspecified
NY02553666Medicaid