Provider Demographics
NPI:1639256548
Name:ALI, IRSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:IRSHAD
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 1:357 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2807
Mailing Address - Country:US
Mailing Address - Phone:716-835-5869
Mailing Address - Fax:716-835-5879
Practice Address - Street 1:357 ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14223-2807
Practice Address - Country:US
Practice Address - Phone:716-835-5869
Practice Address - Fax:716-835-5879
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133793-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0400620OtherINDEPENDENT HEALTH
NY443112731OtherRAILROAD MEDICARE
NY00452680Medicaid
NY00010002401OtherUNIVERA
NY000507637005OtherBLUE CROSS
NY443112731OtherRAILROAD MEDICARE
NY076375Medicare PIN