Provider Demographics
NPI:1285453373
Name:ALI, ABDULRAHIM
Entity type:Individual
Prefix:
First Name:ABDULRAHIM
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 AXE FACTORY RD APT A306
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2140
Mailing Address - Country:US
Mailing Address - Phone:267-370-8230
Mailing Address - Fax:
Practice Address - Street 1:2800 AXE FACTORY RD APT A306
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2140
Practice Address - Country:US
Practice Address - Phone:267-370-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA824816343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)