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General NPI Number Information
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NPI Number | 1831182633
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Entity Type | Organization
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Legal Business Name | ALI M GHARAGOZLOO MD PC
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 214 KING ST
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City | OGDENSBURG
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State | NY
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Zip | 13669-1142
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Country | US
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Telephone | 315-393-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 27 DOCKSIDE DR # 27
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City | MORRISTOWN
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State | NY
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Zip | 13664-3231
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Country | US
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Telephone | 315-393-3600
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR OF GROUP
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Name | DR. ALI M GHARAGOZLOO
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Credential | M.D.
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Telephone | 315-393-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 198556
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License Number State | NY
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