Provider Demographics
NPI:1346221264
Name:ALI, MUHAMMAD NASIR (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:NASIR
Last Name:ALI
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 1:33 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3049
Mailing Address - Country:US
Mailing Address - Phone:516-378-4949
Mailing Address - Fax:516-379-8026
Practice Address - Street 1:33 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3049
Practice Address - Country:US
Practice Address - Phone:516-378-4949
Practice Address - Fax:516-379-8026
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 191321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY395233OtherWELL CARE
NY040426008950OtherFIDELIS
NY01442039Medicaid
NY040426008950OtherFIDELIS
NY01442039Medicaid