Provider Demographics
NPI:1962819508
Name:RAMALLI, ANIS MANSUR MOH
Entity Type:Individual
Prefix:
First Name:ANIS MANSUR MOH
Middle Name:
Last Name:RAMALLI
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 1:8742 ELMHURST AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2511
Mailing Address - Country:US
Mailing Address - Phone:347-393-2141
Mailing Address - Fax:
Practice Address - Street 1:8742 ELMHURST AVE APT 3C
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2511
Practice Address - Country:US
Practice Address - Phone:347-393-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program