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1841516069

NPI Code Detail

MEDICARE: DR. NICOLE MRYTLE ALI MD

MEDICARE: DR. NICOLE MRYTLE ALI 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	207R00000X	Internal Medicine Physician	254095	NY
2	207RN0300X	Nephrology Physician	254095	NY

General Provider Information

NPI Number	:	1841516069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE MRYTLE ALI MD

Provider Business Mailing Address
First Line	:	317 E 34TH ST FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-4910
Country	:	US
Telephone Number	:	212-263-8134
Fax Number	:	212-263-8157

Provider Business Practice Location Address
First Line	:	317 E 34TH ST FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-4910
Country	:	US
Telephone Number	:	212-263-8134
Fax Number	:	212-263-8157

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

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	07/07/2021

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Directions to “ DR. NICOLE MRYTLE ALI MD” Practice Location

Language	Start Address	Practice Location

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