Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 313501 | NY |
NPI | 1093133134 |
---|---|
Provider Name | Dr. Imran Yousuf Ali |
First Address | Bridgeport, CT 06610-2805 |
Second Address | Bridgeport, CT 06610-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2014 |
Last Update Date | 10/11/2021 |