Provider Demographics
NPI:1568491140
Name:ALLIED HEALTHCARE PHYSICIAN PLLC
Entity type:Organization
Organization Name:ALLIED HEALTHCARE PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIJAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-834-1777
Mailing Address - Street 1:444 E BOSTON POST RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3704
Mailing Address - Country:US
Mailing Address - Phone:914-834-1777
Mailing Address - Fax:914-834-0047
Practice Address - Street 1:444 E BOSTON POST RD STE 201
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-834-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230232173000000X
173000000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02611310Medicaid
NY02611310Medicaid