Provider Demographics
NPI:1053075580
Name:MAHDI SUFI AL-WALI EL
Entity Type:Organization
Organization Name:MAHDI SUFI AL-WALI EL
Other - Org Name:MAHDI SUFI AL-WALI EL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAPLAIN
Authorized Official - Prefix:
Authorized Official - First Name:CHAPLIN MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUFI EL
Authorized Official - Suffix:
Authorized Official - Credentials:MAGISTRATE
Authorized Official - Phone:267-815-3494
Mailing Address - Street 1:842 N HUTTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1407
Mailing Address - Country:US
Mailing Address - Phone:612-356-2434
Mailing Address - Fax:
Practice Address - Street 1:263 S 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4148
Practice Address - Country:US
Practice Address - Phone:612-356-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management