Basic Information
Provider Information | |||||||||
NPI: | 1659932341 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AL-TARBSHEH | ||||||||
FirstName: | ALI | ||||||||
MiddleName: | HANI | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 47 NEW SCOTLAND AVENUE | ||||||||
Address2: | DEPARTMENT OF INTERNAL MEDICINE | ||||||||
City: | ALBANY | ||||||||
State: | NY | ||||||||
PostalCode: | 12208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5182625735 | ||||||||
FaxNumber: | 5182625743 | ||||||||
Practice Location | |||||||||
Address1: | 2950 CLEVELAND CLINIC BLVD | ||||||||
Address2: |   | ||||||||
City: | WESTON | ||||||||
State: | FL | ||||||||
PostalCode: | 333313625 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9546595000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/24/2019 | ||||||||
LastUpdateDate: | 05/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TRN34399 | FL | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 390200000X | 64125 | NY | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.