Provider Demographics
NPI:1841439221
Name:ALEXANDER BANGIEV MEDICAL PC
Entity type:Organization
Organization Name:ALEXANDER BANGIEV MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANEGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-683-0286
Mailing Address - Street 1:7333 182ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1523 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3912
Practice Address - Country:US
Practice Address - Phone:718-743-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226004207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74827Medicare UPIN