Healthcare Provider Details

I. General information

NPI: 1932810215
Provider Name (Legal Business Name): MD ALLY SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E WASHINGTON ST STE 300
PHOENIX AZ
85034-1908
US

IV. Provider business mailing address

348 W 57TH ST STE 180
NEW YORK NY
10019-3702
US

V. Phone/Fax

Practice location:
  • Phone: 203-350-2116
  • Fax: 866-326-5428
Mailing address:
  • Phone: 203-350-2116
  • Fax: 866-326-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEGAN CLAY MARINO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 504-451-1781