Provider Demographics
NPI:1043347545
Name:ALAIE, MEHRDAD (DO)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:ALAIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 STACEY CT
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2502
Mailing Address - Country:US
Mailing Address - Phone:914-433-3281
Mailing Address - Fax:
Practice Address - Street 1:4422 THIRD AVENUE
Practice Address - Street 2:ST. BARNABAS HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-6103
Practice Address - Fax:718-960-6125
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248192-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03014362Medicaid
MD412800100Medicaid
MDP00418705OtherRAILROAD
MD451601000Medicaid
NY03014362Medicaid
MDP00418705OtherRAILROAD
NYA400001860Medicare PIN