Provider Demographics
NPI:1568412849
Name:JALEEL, NED (DO)
Entity Type:Individual
Prefix:
First Name:NED
Middle Name:
Last Name:JALEEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1617
Mailing Address - Country:US
Mailing Address - Phone:617-249-4505
Mailing Address - Fax:
Practice Address - Street 1:11 LAUREL DR
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1617
Practice Address - Country:US
Practice Address - Phone:617-249-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1090208M00000X
NY254703208M00000X
MA242289208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013456Medicaid
37159Medicare ID - Type Unspecified
NVV105710Medicare PIN
NV002013456Medicaid