Basic Information
| Provider Information | |||||||||
| NPI: | 1740523448 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ALI | ||||||||
| FirstName: | NISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 BROOKLINE AVENUE | ||||||||
| Address2: | BETH ISRAEL DEACONESS MEDICAL CENTER | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 330 BROOKLINE AVE | ||||||||
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| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176677000 | ||||||||
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| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 04/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.