Individual
ABED AL-MAWLA JANDALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
119867
NY
208600000X
Surgery Physician
Primary
119867
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401344001
BLUE SHIELD
—
05
—
00525177
—
NY
01
—
10002646D252
CDPHP
—
Enumeration date
09/01/2006
Last updated
07/03/2024
Update your record
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