Provider Demographics
NPI:1508959743
Name:TBHC MEDICAL SERVICES, PC
Entity type:Organization
Organization Name:TBHC MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-250-6813
Mailing Address - Street 1:PO BOX 13567
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3567
Mailing Address - Country:US
Mailing Address - Phone:718-250-8621
Mailing Address - Fax:718-250-8878
Practice Address - Street 1:121 DEKALB AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-250-8621
Practice Address - Fax:718-250-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02096871Medicaid
NY02096871Medicaid