Healthcare Provider Details

I. General information

NPI: 1497867865
Provider Name (Legal Business Name): ALI MAHMOUD ABU AL HUMMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E 13TH ST APARTMENT 3 E
NEW YORK NY
10009-3713
US

IV. Provider business mailing address

416 E 13TH ST APARTMENT 3 E
NEW YORK NY
10009-3713
US

V. Phone/Fax

Practice location:
  • Phone: 573-864-1848
  • Fax:
Mailing address:
  • Phone: 573-864-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT2006014649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: