Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 196563 | NY |
NPI | 1023072709 |
---|---|
Provider Name | Ahmed Aly Abdelfadil |
First Address | Colts Neck, NJ 07722-1820 |
Second Address | Staten Island, NY 10309-3118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 05/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G18656 | (02) | NY |