MEDICARE: SAUDIA ALLI ADULT -GERO PC NP

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	363LA2200X	Adult Health Nurse Practitioner	F-306937-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568864908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAUDIA ALLI ADULT -GERO PC NP

Provider Business Mailing Address
First Line	:	8440 153RD AVE
Second Line	:	APT 1A
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1947
Country	:	US
Telephone Number	:	917-478-3090
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 153RD AVE
Second Line	:	APT 1A
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1947
Country	:	US
Telephone Number	:	917-478-3090
Fax Number	:

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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