MEDICARE: MIKAL ALI

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1689432262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAL ALI

Provider Business Mailing Address
First Line	:	3216 BETHEL AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-2710
Country	:	US
Telephone Number	:	856-518-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	3216 BETHEL AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-2710
Country	:	US
Telephone Number	:	856-518-1503
Fax Number	:

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

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	06/14/2026

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Directions to “ MIKAL ALI ” Practice Location

Language	Start Address	Practice Location

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