=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609296383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PIYAL ALAM D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2014
-----------------------------------------------------
Last Update Date | 03/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 S RIDGE ST STE UL-1
-----------------------------------------------------
City | RYE BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-481-5777
-----------------------------------------------------
Fax | 914-481-5267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 S RIDGE ST STE UL-1
-----------------------------------------------------
City | RYE BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-481-5777
-----------------------------------------------------
Fax | 914-481-5267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 281737
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------