Provider Demographics
NPI:1487928693
Name:ADIL H AL-HUMADI, P.C.
Entity type:Organization
Organization Name:ADIL H AL-HUMADI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:AL-HUMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-372-9629
Mailing Address - Street 1:2223 W STATE ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1938
Mailing Address - Country:US
Mailing Address - Phone:716-372-9629
Mailing Address - Fax:716-372-9638
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:SUITE 117
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1938
Practice Address - Country:US
Practice Address - Phone:716-372-9629
Practice Address - Fax:716-372-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120097-1208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001304052OtherBLUE SHIELD OF PA
NY00604480Medicaid
NY283015003OtherTRAVELERS MEDICAER
NY1401542OtherINDEPENDENT HEALTH
NY00010001801OtherUNIVERA
NY000506398001OtherBLUE CROSS/BLUE SHIELD
NY063981Medicare PIN
PA001304052OtherBLUE SHIELD OF PA