Provider Demographics
NPI:1295071850
Name:LOVINGCARE DIABETES PROGRAM @ ALBRIGHT MEDICAL
Entity type:Organization
Organization Name:LOVINGCARE DIABETES PROGRAM @ ALBRIGHT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:AFONNE
Authorized Official - Last Name:AKOBUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:917-297-5037
Mailing Address - Street 1:19108 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1157
Mailing Address - Country:US
Mailing Address - Phone:917-297-5037
Mailing Address - Fax:
Practice Address - Street 1:11134 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?:Yes
Parent Organization LBN:LOVE AKOBUNDU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00711812133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300018544Medicare PIN