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General NPI Number Information
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NPI Number | 1720439417
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Entity Type | Individual
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Provider Name | MAHDI AL IKHWAN
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Gender | Male
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 1276 FULTON AVE 4TH FLOOR FAMILY MEDICINE
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City | BRONX
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State | NY
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Zip | 10456-3402
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Country | US
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Telephone | 718-901-8297
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Fax |
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Provider Business Mailing Address
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Address Line | 10440 QUEENS BLVD APT 4X
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City | FOREST HILLS
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State | NY
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Zip | 11375-3637
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AT-1823194
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License Number State | NY
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