Basic Information
| Provider Information | |||||||||
| NPI: | 1346472826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALI | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | ARMOGHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 LEROY ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152653300 | ||||||||
| FaxNumber: | 3152616025 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 RAYMOND ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152659271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125056998 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 31880 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 296489 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 125056998 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 511-30395 (SBC) | 01 | AL | BLUE CROSS | OTHER | 183210 | 05 | AL | MEDICAID | 141862 (SBC) | 05 | AL | MEDICAID | 142072 (STEWART) | 05 | AL | MEDICAID | 511-30389 (COMPLEX) | 01 | AL | BLUE CROSS | OTHER | 511-73964 | 01 | AL | BCBS OF ALABAMA | OTHER | 141861 (COMPLEX) | 05 | AL | MEDICAID | 511-30392(STEWART) | 01 | AL | BLUE CROSS | OTHER |