Healthcare Provider Details

I. General information

NPI: 1750783817
Provider Name (Legal Business Name): MR. RIYADH ALLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 09/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE MC 131
ALBANY NY
12208-3412
US

IV. Provider business mailing address

501 ACRE DR
SCHENECTADY NY
12303-5201
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3125
  • Fax:
Mailing address:
  • Phone: 518-441-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number594459-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: