MEDICARE: AHMED ALY ABDELFADIL PHYSICIAN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	196563	NY
2	207RP1001X	Pulmonary Disease Physician	196563	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8V3011	OTHER	NY	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194736132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHMED ALY ABDELFADIL PHYSICIAN PC

Provider Business Mailing Address
First Line	:	4 SQUAN SONG LANE
Second Line	:	SECOND FLOOR
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1820
Country	:	US
Telephone Number	:	718-605-2970
Fax Number	:	718-605-7180

Provider Business Practice Location Address
First Line	:	5947 AMBOY RD.
Second Line	:	SECOND FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3118
Country	:	US
Telephone Number	:	718-605-2970
Fax Number	:	718-605-7180

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AHMED ALY ABDELFADIL
Credential	:	M.D.
Telephone Number	:	718-761-2950

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	04/25/2011

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