Healthcare Provider Details

I. General information

NPI: 1477598191
Provider Name (Legal Business Name): MISHAL ALI ALKASIMI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 74TH ST
BROOKLYN NY
11209-1904
US

IV. Provider business mailing address

97 74TH ST
BROOKLYN NY
11209-1904
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-6204
  • Fax: 718-238-6205
Mailing address:
  • Phone: 718-238-6204
  • Fax: 718-238-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number238311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: