Provider Demographics
NPI:1811293350
Name:ALI BANKI, D.O., P.C.
Entity type:Organization
Organization Name:ALI BANKI, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-659-2779
Mailing Address - Street 1:15 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2135
Mailing Address - Country:US
Mailing Address - Phone:860-659-2779
Mailing Address - Fax:860-633-9315
Practice Address - Street 1:15 CONCORD ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2135
Practice Address - Country:US
Practice Address - Phone:860-659-2779
Practice Address - Fax:860-633-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048744207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT048744OtherCONNECTICARE, INC.
CT6426153OtherAETNA
CTP4181742OtherOXFORD
CT040048744CT01OtherANTHEM BLUE CROSS/BLUE SHIELD
CT6426153OtherAETNA