Healthcare Provider Details

I. General information

NPI: 1659378172
Provider Name (Legal Business Name): ALPHA-K FAMILY MEDICAL PRACTICE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 153RD ST
FLUSHING NY
11367-3937
US

IV. Provider business mailing address

7935 153RD ST
FLUSHING NY
11367-3937
US

V. Phone/Fax

Practice location:
  • Phone: 718-591-1600
  • Fax: 718-591-0265
Mailing address:
  • Phone: 718-591-1600
  • Fax: 718-591-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202847
License Number StateNY

VIII. Authorized Official

Name: DR. EMMANUEL O FASHAKIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-591-1600