MEDICARE: ALI AHMADIZADEH 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	254098	NY
2	207Y00000X	Otolaryngology Physician	254098	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1376598805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI AHMADIZADEH MD

Provider Business Mailing Address
First Line	:	875 OLD COUNTRY RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-931-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 OLD COUNTRY RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-931-5552
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/30/2021

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