Healthcare Provider Details

I. General information

NPI: 1023707908
Provider Name (Legal Business Name): ALI USAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF INTERNAL MEDICINE, WYCKOFF HEIGHTS MEDICA 374 STOCKHOLM STREET
BROOKLYN NY
11237
US

IV. Provider business mailing address

DEPARTMENT OF INTERNAL MEDICINE, WYCKOFF HEIGHTS MEDICA 374 STOCKHOLM STREET
BROOKLYN NY
11237
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7585
  • Fax:
Mailing address:
  • Phone: 718-963-7585
  • Fax: 718-486-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0029279
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: