Provider Demographics
NPI:1518416908
Name:ALI, ARAFAT (N/A)
Entity Type:Individual
Prefix:MR
First Name:ARAFAT
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-3847
Mailing Address - Country:US
Mailing Address - Phone:845-265-8294
Mailing Address - Fax:
Practice Address - Street 1:3315 ROUTE 9
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-3847
Practice Address - Country:US
Practice Address - Phone:845-265-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667173475172A00000X
NY261172371172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03112489Medicaid