Provider Demographics
NPI:1326117847
Name:ALI, DASSAN (SCD, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:DASSAN
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:SCD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3205
Mailing Address - Country:US
Mailing Address - Phone:718-745-2826
Mailing Address - Fax:718-745-0040
Practice Address - Street 1:447 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3205
Practice Address - Country:US
Practice Address - Phone:718-745-2826
Practice Address - Fax:718-745-0040
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002121231H00000X
NY14000024556237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLICENSEOther002121
NYLICENSEOther002121