Provider Demographics
NPI:1922281344
Name:WALI MOHAMMAD, M.D., P.C.
Entity Type:Organization
Organization Name:WALI MOHAMMAD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-918-9158
Mailing Address - Street 1:2880 BAISLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6117
Mailing Address - Country:US
Mailing Address - Phone:718-918-9158
Mailing Address - Fax:718-822-3990
Practice Address - Street 1:2880 BAISLEY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6117
Practice Address - Country:US
Practice Address - Phone:718-918-9158
Practice Address - Fax:718-822-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1353442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWB2311Medicare PIN