Basic Information
Provider Information | |||||||||
NPI: | 1174085534 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | UDDIN | ||||||||
FirstName: | MD ALAL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4 CENTER CT | ||||||||
Address2: | BETHPAGE | ||||||||
City: | BETHPAGE | ||||||||
State: | NY | ||||||||
PostalCode: | 11714 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5162963389 | ||||||||
FaxNumber: | 5165725140 | ||||||||
Practice Location | |||||||||
Address1: | 2201 HEMPSTEAD TURNPIKE | ||||||||
Address2: |   | ||||||||
City: | EAST MEADOW | ||||||||
State: | NY | ||||||||
PostalCode: | 11554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5162963389 | ||||||||
FaxNumber: | 5165725140 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/04/2019 | ||||||||
LastUpdateDate: | 11/18/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: | 11/07/2019 | ||||||||
NPIReactivationDate: | 11/18/2019 | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.