Healthcare Provider Details

I. General information

NPI: 1457042459
Provider Name (Legal Business Name): AMMAR AL-WARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 12/21/2023
Certification Date: 05/19/2023
Deactivation Date: 12/21/2023
Reactivation Date: 12/21/2023

III. Provider practice location address

1901 FIRST AVENUE (DEPARTMENT OF PEDIATRICS, METROPOLIT 15TH FLOOR ROOM 15B-1
NEW YORK NY
10029
US

IV. Provider business mailing address

1901 FIRST AVENUE (DEPARTMENT OF PEDIATRICS, METROPOLIT 15TH FLOOR ROOM 15B-1
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6271
  • Fax: 212-534-7831
Mailing address:
  • Phone: 212-423-6271
  • Fax: 212-534-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: