Healthcare Provider Details

I. General information

NPI: 1346344512
Provider Name (Legal Business Name): ABDULLA - ALWANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 73RD ST
BROOKLYN NY
11209-2109
US

IV. Provider business mailing address

217 73ED ST 1ST FLOOR
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-921-0074
  • Fax: 718-238-7991
Mailing address:
  • Phone: 718-921-0074
  • Fax: 718-238-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: