Abed Al-Mawla Jandali, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

119867 Issued in NY

Practice address

13 Arch Street
Green Island, NY 12183

Phone

(518) 274-4654

Fax

(518) 274-4654

NPI assigned

Sep 1, 2006

Reactivated

May 30, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: General Practice, General Surgery

Education

Other, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Samaritan Hospital of Troy, New York Hospital, Troy, NY, CCN 330180

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abed Al-Mawla Jandali M.D. PC

  • Primary Care Clinic/Center
  • Green Island, NY
  • NPI 1083950117
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1003918277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 ARCH STREET",
            "city": "GREEN ISLAND",
            "state": "NY",
            "postal_code": "12183",
            "telephone_number": "518-274-4654",
            "fax_number": "518-274-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 ARCH STREET",
            "city": "GREEN ISLAND",
            "state": "NY",
            "postal_code": "12183",
            "telephone_number": "518-274-4654",
            "fax_number": "518-274-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANDALI",
        "first_name": "ABED",
        "middle_name": "AL-MAWLA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "deactivation_date": "2024-05-01",
        "reactivation_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "119867",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "119867",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10002646D252",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000401344001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00525177",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Empire Home Infusion Service Inc (Northeast Home Medical Equipment)
• George Jeffrey Glikes, DDS
• Green Island Union Free School District
• Patience Gully
• William J Hennessey, MD PC
• Pamela Kaw, MD
• Elisabeth Kusiak, PA-C
• Bennett Ira Lax, D.D.S.
• Jeffrey Alan Macdonald Jr.
• Andrea Mason

• Surgery Physician in Green Island, NY
• Providers in Green Island, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.