Provider Demographics
NPI:1073948857
Name:ALLI, ASIM (CPED)
Entity Type:Individual
Prefix:MR
First Name:ASIM
Middle Name:
Last Name:ALLI
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0728
Mailing Address - Country:US
Mailing Address - Phone:540-904-7823
Mailing Address - Fax:540-904-7826
Practice Address - Street 1:4252 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0728
Practice Address - Country:US
Practice Address - Phone:540-904-7823
Practice Address - Fax:540-904-7826
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCPED1409224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist