Provider Demographics
NPI:1245935824
Name:ALLY MEDICAL PC
Entity type:Organization
Organization Name:ALLY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-764-6464
Mailing Address - Street 1:6918 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2033
Mailing Address - Country:US
Mailing Address - Phone:718-639-9100
Mailing Address - Fax:516-217-0772
Practice Address - Street 1:30 HEMPSTEAD AVE STE 144
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4034
Practice Address - Country:US
Practice Address - Phone:516-764-6464
Practice Address - Fax:516-217-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY257228OtherLICENSE