MEDICARE: ALI RAZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	062744	NY

General Provider Information

NPI Number	:	1033788302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI RAZA

Provider Business Mailing Address
First Line	:	201 50TH AVE APT 25E
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-6511
Country	:	US
Telephone Number	:	989-327-3822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	02/19/2024

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Directions to “ ALI RAZA ” Practice Location

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