Provider Demographics
NPI:1619918562
Name:AZIZ, ALI SAYED (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SAYED
Last Name:AZIZ
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 1:400 CARNEY ST APT 405
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4397
Mailing Address - Country:US
Mailing Address - Phone:757-812-9522
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:613-654-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4497032084P0800X
CT0337742084P0800X
VA01012321032084P0800X
NY1965742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA212540OtherTRICARE
VA717528Medicaid
VA298648OtherMAMSI
KY33515OtherKY LICENSE NUMBER
VA0101232103OtherVA LICENSE
NY196574OtherNY LICENSE
KY33515OtherKY LICENSE NUMBER
KY33515OtherKY LICENSE NUMBER