| Abbydek Family Medical Practice Pc | |
|
7935 153rd St Apt 1 Flushing NY 11367-3937 | |
| (718) 591-1600 | |
| (718) 591-0265 |
| Full Name | Abbydek Family Medical Practice Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7935 153rd St, Flushing, New York |
| Authorized Official Name and Position | Emmanuel Olusegun Fashakin (PRESIDENT) |
| Authorized Official Contact | 7185911600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abbydek Family Medical Practice Pc 7935 153rd St Apt 1 Flushing NY 11367-3937 Ph: (718) 591-1600 | Abbydek Family Medical Practice Pc 7935 153rd St Apt 1 Flushing NY 11367-3937 Ph: (718) 591-1600 |
| NPI Number | 1447535323 |
|---|---|
| Provider Enumeration Date | 10/11/2011 |
| Last Update Date | 10/11/2011 |
| Medicare PECOS PAC ID | 7416121561 |
|---|---|
| Medicare Enrollment ID | O20111129000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447535323 | NPI | - | NPPES |
| 01652235 | Medicaid | NY | |
| 202847 | Other | NY | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 202847 (New York) | Primary |
| Provider Name | Emmanuel O Fashakin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922154681 PECOS PAC ID: 2365402773 Enrollment ID: I20050202000713 |
| Provider Name | Abby Nimotalai Fashakin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952799033 PECOS PAC ID: 0244557049 Enrollment ID: I20150316000332 |
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