Healthcare Provider Details

I. General information

NPI: 1275760100
Provider Name (Legal Business Name): MOHAMMED ABDUL-ALEEM HADI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JERUSALEM AVE
LEVITTOWN NY
11756-3718
US

IV. Provider business mailing address

100 JERUSALEM AVE
LEVITTOWN NY
11756-3718
US

V. Phone/Fax

Practice location:
  • Phone: 516-513-0836
  • Fax: 516-342-1452
Mailing address:
  • Phone: 631-736-4064
  • Fax: 516-342-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number254487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: