Provider Demographics
NPI:1063446631
Name:ALI, SHAIK M (MD)
Entity Type:Individual
Prefix:
First Name:SHAIK
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:37 CLIFTON STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:718-850-0707
Mailing Address - Fax:718-850-9405
Practice Address - Street 1:101-20 LEFFERTS BLVD.
Practice Address - Street 2:
Practice Address - City:S. RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-850-0707
Practice Address - Fax:718-850-9405
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY192787207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01720061Medicaid
NYG37764Medicare UPIN
NY01720061Medicaid