Healthcare Provider Details

I. General information

NPI: 1619918562
Provider Name (Legal Business Name): ALI SAYED AZIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772
US

IV. Provider business mailing address

400 CARNEY ST APT 405
GLEN COVE NY
11542-4397
US

V. Phone/Fax

Practice location:
  • Phone: 613-654-7100
  • Fax:
Mailing address:
  • Phone: 757-812-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD449703
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number033774
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101232103
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number196574
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier212540
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerTRICARE
# 2
Identifier717528
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 3
Identifier298648
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerMAMSI
# 4
Identifier33515
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerKY LICENSE NUMBER
# 5
Identifier0101232103
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerVA LICENSE
# 6
Identifier196574
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNY LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: