Individual
KHAMEINEI ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 N BROADWAY, SLEEPY HOLLOW, NY 10591-1020
(914) 366-3590
Mailing address
701 N BROADWAY, SLEEPY HOLLOW, NY 10591-1020
(914) 366-3590
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
304891
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304891
NYS MEDICAL BOARD
NY
Enumeration date
04/07/2016
Last updated
06/04/2020
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