Healthcare Provider Details

I. General information

NPI: 1568412849
Provider Name (Legal Business Name): NED JALEEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LAUREL DR
LOUDONVILLE NY
12211-1617
US

IV. Provider business mailing address

11 LAUREL DR
LOUDONVILLE NY
12211-1617
US

V. Phone/Fax

Practice location:
  • Phone: 617-249-4505
  • Fax:
Mailing address:
  • Phone: 617-249-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1090
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number254703
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number242289
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: