Provider Demographics
NPI:1376873745
Name:ALAM, ANIS (MD)
Entity Type:Individual
Prefix:
First Name:ANIS
Middle Name:
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:921 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1401
Mailing Address - Country:US
Mailing Address - Phone:718-483-8566
Mailing Address - Fax:718-483-8850
Practice Address - Street 1:921 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1401
Practice Address - Country:US
Practice Address - Phone:718-483-8566
Practice Address - Fax:718-483-8850
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY255620-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine