Individual
ALTAF ANSARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 MILVIA ST, BERKELEY, CA 94704-2636
(510) 204-5514
(510) 204-5515
Mailing address
407 AIRPORT EXE PARK, NANUET, NY 10954
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
164300
NY
207P00000X
Emergency Medicine Physician
Primary
352047
CA
207R00000X
Internal Medicine Physician
164300
NY
207R00000X
Internal Medicine Physician
352047
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01016366
—
NY
01
—
C56132
STATE MEDICAL LICENSE
CA
Enumeration date
01/17/2007
Last updated
08/10/2022
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