Provider Demographics
NPI:1205721560
Name:ALI, MARIAM (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5915
Mailing Address - Country:US
Mailing Address - Phone:347-658-4723
Mailing Address - Fax:
Practice Address - Street 1:10 LEWIS ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5915
Practice Address - Country:US
Practice Address - Phone:347-658-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant