Provider Demographics
NPI:1508837287
Name:ABOUFARES, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ABOUFARES
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 1:115 E 57TH ST
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2049
Mailing Address - Country:US
Mailing Address - Phone:212-319-3977
Mailing Address - Fax:212-319-4263
Practice Address - Street 1:115 E 57TH ST
Practice Address - Street 2:SUITE 1240
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2049
Practice Address - Country:US
Practice Address - Phone:212-319-3977
Practice Address - Fax:212-319-4263
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426289207RI0011X
NY244925207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673063Medicaid
PA1013506880001Medicaid
PACC9269OtherRR MEDICARE GROUP
PAGU039823OtherMEDICARE GROUP
PAP00234348OtherRAILROAD MEDICARE PIN
NY02673063Medicaid
PAP00234348OtherRAILROAD MEDICARE PIN