Basic Information
Provider Information
NPI: 1275270563
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALI
FirstName: MALIK
MiddleName: AHMED
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 31 E 32ND STREET
Address2: 4TH FLOOR
City: NEW YORK
State: NY
PostalCode: 100166575
CountryCode: US
TelephoneNumber: 2127592282
FaxNumber: 2123792123
Practice Location
Address1: 11 W 67TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100236237
CountryCode: US
TelephoneNumber: 6469735431
FaxNumber: 2124004229
Other Information
ProviderEnumerationDate: 05/18/2022
LastUpdateDate: 05/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X047763NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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