Healthcare Provider Details

I. General information

NPI: 1245962745
Provider Name (Legal Business Name): ALEXANDRIA PODIATRY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 PADDINGTON RD
MAHWAH NJ
07430-3257
US

IV. Provider business mailing address

252 CEDRUS AVE
EAST NORTHPORT NY
11731-4515
US

V. Phone/Fax

Practice location:
  • Phone: 347-324-2441
  • Fax: 718-310-3313
Mailing address:
  • Phone: 347-324-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KHALED AHMED
Title or Position: PRESIDENT
Credential: DPM
Phone: 347-324-2441