Provider Demographics
NPI:1952813693
Name:ALI, ALI MOHAMED
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:MOHAMED
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 STEUBEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-4922
Mailing Address - Country:US
Mailing Address - Phone:315-765-1377
Mailing Address - Fax:
Practice Address - Street 1:1537 STEUBEN ST APT 2
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4922
Practice Address - Country:US
Practice Address - Phone:315-765-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker