Provider Demographics
NPI:1841391695
Name:ELMONT MEDICAL PC
Entity Type:Organization
Organization Name:ELMONT MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AKWASI
Authorized Official - Middle Name:AFRIYI
Authorized Official - Last Name:ACHAMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-354-5600
Mailing Address - Street 1:PO BOX 30682
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0682
Mailing Address - Country:US
Mailing Address - Phone:516-654-5600
Mailing Address - Fax:516-354-1480
Practice Address - Street 1:135 ROCKMART AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1731
Practice Address - Country:US
Practice Address - Phone:516-354-5600
Practice Address - Fax:516-354-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216449261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWPPD01Medicare PIN
NY05952Medicare PIN