Basic Information
| Provider Information | |||||||||
| NPI: | 1730264441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALAM | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | JAHANGIR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 WESTMINSTER CT S | ||||||||
| Address2: | |||||||||
| City: | NESCONSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117671882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317806795 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 PATRIOTS RD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117903318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314448608 | ||||||||
| FaxNumber: | 6314448778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 217943 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 217943 | 01 | NY | NYS LICENSE | OTHER |