Healthcare Provider Details

I. General information

NPI: 1801899877
Provider Name (Legal Business Name): ALI HAMMOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GRAND ST STE 106
KINGSTON NY
12401-3933
US

IV. Provider business mailing address

1351 ROUTE 55 STE 200
LAGRANGEVILLE NY
12540-5128
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-8700
  • Fax: 914-593-7881
Mailing address:
  • Phone: 845-475-9661
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number205896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: