Healthcare Provider Details

I. General information

NPI: 1336002252
Provider Name (Legal Business Name): ALI FATEHI HASSANABAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

606 W 57TH ST APT 1601
NEW YORK NY
10019-1379
US

V. Phone/Fax

Practice location:
  • Phone: 403-903-7952
  • Fax:
Mailing address:
  • Phone: 403-903-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number337937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: