Provider Demographics
NPI:1639527021
Name:ALI, NAHLA (MS)
Entity Type:Individual
Prefix:
First Name:NAHLA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 CRESCENT ST
Mailing Address - Street 2:4L
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3857
Mailing Address - Country:US
Mailing Address - Phone:718-570-1964
Mailing Address - Fax:
Practice Address - Street 1:3343 CRESCENT ST
Practice Address - Street 2:4L
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:718-570-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1292727390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program