Provider Demographics
NPI:1164229472
Name:ALTAF, ALI HEIDAR
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:HEIDAR
Last Name:ALTAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ALBIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7401
Mailing Address - Country:US
Mailing Address - Phone:917-688-5749
Mailing Address - Fax:
Practice Address - Street 1:701 ALBIN AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7401
Practice Address - Country:US
Practice Address - Phone:917-688-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant