Provider Demographics
NPI:1548482631
Name:AMIR ABDALLA MOHAMED ALI
Entity type:Organization
Organization Name:AMIR ABDALLA MOHAMED ALI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-418-6078
Mailing Address - Street 1:1100 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830
Mailing Address - Country:US
Mailing Address - Phone:732-283-9788
Mailing Address - Fax:732-283-9784
Practice Address - Street 1:1100 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-283-9788
Practice Address - Fax:732-283-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJADDI00019343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7444206OtherMEDCAID