MEDICARE: MAHMOUD HASSAN ALY M.D.

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	207RH0003X	Hematology & Oncology Physician	185995-1	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	:	1699791459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHMOUD HASSAN ALY M.D.

Provider Business Mailing Address
First Line	:	2 TRICORNE CT
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1250
Country	:	US
Telephone Number	:
Fax Number	:	732-796-9334

Provider Business Practice Location Address
First Line	:	1910 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2552
Country	:	US
Telephone Number	:	718-987-9777
Fax Number	:	718-987-9556

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/14/2019

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