Provider Demographics
NPI:1942412218
Name:ALI, SYED MONZURUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:MONZURUL
Last Name:ALI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 RIVER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8005
Mailing Address - Country:US
Mailing Address - Phone:718-681-0020
Mailing Address - Fax:718-681-0020
Practice Address - Street 1:1197 RIVER AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8005
Practice Address - Country:US
Practice Address - Phone:718-681-0020
Practice Address - Fax:718-681-0020
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD00043602OtherAMERICHOICE
NY0008398OtherDORAL DENTAL
NY01635381Medicaid