Provider Demographics
NPI:1144335977
Name:ALLIANCE FAMILY MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:ALLIANCE FAMILY MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUHAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-486-0094
Mailing Address - Street 1:183 BROADWAY STE 308
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4242
Mailing Address - Country:US
Mailing Address - Phone:516-486-0094
Mailing Address - Fax:516-486-0110
Practice Address - Street 1:183 BROADWAY STE 308
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4242
Practice Address - Country:US
Practice Address - Phone:516-486-0094
Practice Address - Fax:516-486-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236676261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02702821Medicaid
I34392Medicare UPIN
NY02702821Medicaid