Provider Demographics
NPI:1134338122
Name:ALI, KHORSHEDA BEGUM (DO)
Entity type:Individual
Prefix:
First Name:KHORSHEDA
Middle Name:BEGUM
Last Name:ALI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:23 LAKEWOOD AVE
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2021
Practice Address - Country:US
Practice Address - Phone:845-794-2010
Practice Address - Fax:845-794-4569
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY242868-1207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02900654Medicaid
NYAA0598OtherMEDICARE GROUP
NYAA0598OtherMEDICARE GROUP
NYRB5110Medicare PIN