Healthcare Provider Details

I. General information

NPI: 1255880738
Provider Name (Legal Business Name): AHMAD ABDELAAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1197
US

IV. Provider business mailing address

4234 TALWOOD LN
TOLEDO OH
43606-1062
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-2583
  • Fax:
Mailing address:
  • Phone: 901-340-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.136810
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35.136810
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD458391
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number35.136810
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: