Provider Demographics
NPI:1285797043
Name:PREVENTIVE MEDICINE PC
Entity type:Organization
Organization Name:PREVENTIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-873-2444
Mailing Address - Street 1:95 E MAIN ST
Mailing Address - Street 2:101
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2158
Mailing Address - Country:US
Mailing Address - Phone:973-586-4111
Mailing Address - Fax:973-586-8466
Practice Address - Street 1:140 W END AVE
Practice Address - Street 2:1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6131
Practice Address - Country:US
Practice Address - Phone:212-873-2444
Practice Address - Fax:212-873-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW33891Medicare ID - Type Unspecified