Provider Demographics
NPI:1699791459
Name:ALY, MAHMOUD HASSAN (MD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:HASSAN
Last Name:ALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TRICORNE CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:732-796-9334
Practice Address - Street 1:1910 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2552
Practice Address - Country:US
Practice Address - Phone:718-987-9777
Practice Address - Fax:718-987-9556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185995-1207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01644435Medicaid
NY808472Medicare ID - Type Unspecified
NY01644435Medicaid