Healthcare Provider Details

I. General information

NPI: 1932944618
Provider Name (Legal Business Name): ALLY INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WESTCHESTER AVE
BRONX NY
10462-4507
US

IV. Provider business mailing address

6918 32ND AVE
WOODSIDE NY
11377-2033
US

V. Phone/Fax

Practice location:
  • Phone: 516-615-5199
  • Fax: 516-217-0772
Mailing address:
  • Phone: 516-615-5199
  • Fax: 516-217-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEEM ALI
Title or Position: OWNER
Credential: MD
Phone: 516-764-6464