Basic Information
| Provider Information | |||||||||
| NPI: | 1104355700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SINA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10632 N SCOTTSDALE RD # B-225 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852546164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806076825 | ||||||||
| FaxNumber: | 4806078133 | ||||||||
| Practice Location | |||||||||
| Address1: | 5620 W THUNDERBIRD RD STE B3 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027957256 | ||||||||
| FaxNumber: | 6027957257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2017 | ||||||||
| LastUpdateDate: | 06/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | EL-GENGAIHY | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 4806076825 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
No ID Information.