MEDICARE: DR. ALI FATEHI HASSANABAD MD

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	246XC2901X	Cardiovascular Invasive Specialist/Technologist	337937	NY

General Provider Information

NPI Number	:	1336002252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI FATEHI HASSANABAD MD

Provider Business Mailing Address
First Line	:	606 W 57TH ST APT 1601
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1379
Country	:	US
Telephone Number	:	403-903-7952
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 FORT WASHINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3733
Country	:	US
Telephone Number	:	403-903-7952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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