Basic Information
| Provider Information | |||||||||
| NPI: | 1043347545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALAIE | ||||||||
| FirstName: | MEHRDAD | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 STACEY CT | ||||||||
| Address2: | |||||||||
| City: | PEEKSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105662502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144333281 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4422 THIRD AVENUE | ||||||||
| Address2: | ST. BARNABAS HOSPITAL | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189606103 | ||||||||
| FaxNumber: | 7189606125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 10/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 248192-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03014362 | 05 | NY | MEDICAID | 412800100 | 05 | MD | MEDICAID | P00418705 | 01 | MD | RAILROAD | OTHER | 451601000 | 05 | MD | MEDICAID |