Provider Demographics
NPI:1053973735
Name:ALI, ANUM FATIMA (DMD)
Entity type:Individual
Prefix:
First Name:ANUM
Middle Name:FATIMA
Last Name:ALI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SPOTSWOOD GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8679
Mailing Address - Country:US
Mailing Address - Phone:610-908-2353
Mailing Address - Fax:
Practice Address - Street 1:200 W 15TH ST STE SUITE1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6658
Practice Address - Country:US
Practice Address - Phone:347-609-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02809700122300000X
390200000X
NY061248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program