Provider Demographics
NPI:1679546204
Name:ALI, USMAN HASSAN (RPAC)
Entity Type:Individual
Prefix:MR
First Name:USMAN
Middle Name:HASSAN
Last Name:ALI
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 PARK AVE
Mailing Address - Street 2:HUNTINGTON HOSPITAL NSLIJ
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2787
Mailing Address - Country:US
Mailing Address - Phone:631-351-2000
Mailing Address - Fax:
Practice Address - Street 1:270 PARK AVE
Practice Address - Street 2:HUNTINGTON HOSPITAL NSLIJ
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2787
Practice Address - Country:US
Practice Address - Phone:631-351-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010455-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010455-1OtherSTATE LICENSE
NYMA1182550OtherDEA