Basic Information
| Provider Information | |||||||||
| NPI: | 1417620303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | HUSSEIN | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5904 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168865493 | ||||||||
| FaxNumber: | 7168865835 | ||||||||
| Practice Location | |||||||||
| Address1: | 5904 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168865493 | ||||||||
| FaxNumber: | 7168865835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2021 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | F403543-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.