Provider Demographics
NPI:1093167710
Name:ALI, IHOTU JENNIFER (MPH, LMT)
Entity Type:Individual
Prefix:MS
First Name:IHOTU
Middle Name:JENNIFER
Last Name:ALI
Suffix:
Gender:F
Credentials:MPH, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W 113TH ST
Mailing Address - Street 2:GARDEN LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3312
Mailing Address - Country:US
Mailing Address - Phone:952-212-4499
Mailing Address - Fax:
Practice Address - Street 1:531 50TH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:952-212-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27 028559174400000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN