Provider Demographics
NPI:1477218089
Name:MD ALLY SERVICES, PA
Entity Type:Organization
Organization Name:MD ALLY SERVICES, PA
Other - Org Name:MD ALLY TELEHEALTH SERVICES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-287-4250
Mailing Address - Street 1:348 W 57TH ST STE 180
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3702
Mailing Address - Country:US
Mailing Address - Phone:203-350-2116
Mailing Address - Fax:866-326-5428
Practice Address - Street 1:7900 OAK LN STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6001
Practice Address - Country:US
Practice Address - Phone:925-212-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147196Medicaid
FL114428800Medicaid