Provider Demographics
NPI:1962479717
Name:ALI A ALLEY MD PC
Entity Type:Organization
Organization Name:ALI A ALLEY MD PC
Other - Org Name:ALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-759-0351
Mailing Address - Street 1:301W 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-759-0351
Mailing Address - Fax:570-759-1992
Practice Address - Street 1:301W 3RD STREET
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-759-0351
Practice Address - Fax:570-759-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03161300OtherBC
PA1007302700004Medicaid
PA1007302700004Medicaid