Provider Demographics
NPI:1194736132
Name:AHMED ALY ABDELFADIL PHYSICIAN PC
Entity type:Organization
Organization Name:AHMED ALY ABDELFADIL PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:ALY
Authorized Official - Last Name:ABDELFADIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-761-2950
Mailing Address - Street 1:4 SQUAN SONG LANE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1820
Mailing Address - Country:US
Mailing Address - Phone:718-605-2970
Mailing Address - Fax:718-605-7180
Practice Address - Street 1:5947 AMBOY RD.
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3118
Practice Address - Country:US
Practice Address - Phone:718-605-2970
Practice Address - Fax:718-605-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196563207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8V3011OtherMEDICARE ID
NY01993008Medicaid