Provider Demographics
NPI:1942530977
Name:ALI, IFTIKHAR (MD)
Entity Type:Individual
Prefix:
First Name:IFTIKHAR
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 1:8 QUAIL HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1284
Mailing Address - Country:US
Mailing Address - Phone:203-733-4046
Mailing Address - Fax:
Practice Address - Street 1:60 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7171
Practice Address - Country:US
Practice Address - Phone:203-380-5945
Practice Address - Fax:203-380-5953
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047019207U00000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology