Provider Demographics
NPI:1306627088
Name:ELMALLAH, AHMED MOHAMED ALI
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOHAMED ALI
Last Name:ELMALLAH
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 1:13241 41ST RD FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4235
Mailing Address - Country:US
Mailing Address - Phone:929-588-7633
Mailing Address - Fax:917-285-2943
Practice Address - Street 1:13241 41ST RD FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4235
Practice Address - Country:US
Practice Address - Phone:929-588-7633
Practice Address - Fax:917-285-2943
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care