Individual
ABED AL-MAWLA JANDALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13 ARCH STREET, GREEN ISLAND, NY 12183
(518) 274-4654
(518) 274-4654
Mailing address
13 ARCH STREET, GREEN ISLAND, NY 12183
(518) 274-4654
(518) 274-4654
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
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