1508837287 NPI number — DR. ALI ABOUFARES MD

Table of content: DR. ALI ABOUFARES MD (NPI 1508837287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508837287 NPI number — DR. ALI ABOUFARES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABOUFARES
Provider First Name:
ALI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508837287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 E 57TH ST
Provider Second Line Business Mailing Address:
SUITE 1240
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-319-3977
Provider Business Mailing Address Fax Number:
212-319-4263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 E 57TH ST
Provider Second Line Business Practice Location Address:
SUITE 1240
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-319-3977
Provider Business Practice Location Address Fax Number:
212-319-4263
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  MD426289 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 244925 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02673063 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013506880001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC9269 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: GU039823 . This is a "MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00234348 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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