Provider Demographics
NPI:1508930983
Name:ALI, BASHARAT (MD)
Entity Type:Individual
Prefix:
First Name:BASHARAT
Middle Name:
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 1:3085 HARLEM RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:3850 SAUNDERS SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9128
Practice Address - Country:US
Practice Address - Phone:716-898-2800
Practice Address - Fax:716-898-2805
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02010979Medicaid
NY2510925OtherIH
NY000525098006OtherBCBS
NYCC4113Medicare ID - Type UnspecifiedMEDICARE
NYF96983Medicare UPIN