Healthcare Provider Details

I. General information

NPI: 1477218089
Provider Name (Legal Business Name): MD ALLY SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 OAK LN STE 400
MIAMI LAKES FL
33016-6001
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 925-212-1114
  • Fax:
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
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANEL FIELDS
Title or Position: CHIEF OFFICER
Credential:
Phone: 212-287-4250