Provider Demographics
NPI:1093204307
Name:KHALESSI HOSSEINI, SEYED ALI (MD)
Entity type:Individual
Prefix:
First Name:SEYED ALI
Middle Name:
Last Name:KHALESSI HOSSEINI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10919 72ND RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7826
Mailing Address - Country:US
Mailing Address - Phone:718-459-8460
Mailing Address - Fax:718-268-2311
Practice Address - Street 1:10919 72ND RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7826
Practice Address - Country:US
Practice Address - Phone:718-268-0418
Practice Address - Fax:718-268-2311
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309659207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology