Healthcare Provider Details

I. General information

NPI: 1154248672
Provider Name (Legal Business Name): ALBERT CHE NJI IX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3839 64TH AVE APT 509
HYATTSVILLE MD
20784-1810
US

IV. Provider business mailing address

3839 64TH AVE APT 509
HYATTSVILLE MD
20784-1810
US

V. Phone/Fax

Practice location:
  • Phone: 202-339-1289
  • Fax:
Mailing address:
  • Phone: 202-339-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10276179074
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: