Healthcare Provider Details

I. General information

NPI: 1851487482
Provider Name (Legal Business Name): IKBAL HALIM GHANIM-ALALI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

7901 BROADWAY # D1-01
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-2698
  • Fax: 718-334-5006
Mailing address:
  • Phone: 718-334-1920
  • Fax: 718-334-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000582
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: