Provider Demographics
NPI:1114132479
Name:MIRHOSSEINI, ALI SEID (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SEID
Last Name:MIRHOSSEINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MURRAY LN
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3300
Mailing Address - Country:US
Mailing Address - Phone:914-762-4636
Mailing Address - Fax:914-762-4652
Practice Address - Street 1:15211 89TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3730
Practice Address - Country:US
Practice Address - Phone:718-558-2463
Practice Address - Fax:718-558-2178
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115279170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947044Medicaid