Individual provider Active NPI

Ali N/a Imran

  • Physician Assistant
  • Manhasset, NY
National Provider Identifier
1083269120
Registry record updated Aug 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
300 Community Dr
Manhasset, NY 11030-3876
Phone
(516) 562-0100
NPI assigned
Aug 6, 2019
Last updated
Aug 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NY Primary

Addresses

Primary practice location

300 Community Dr
Manhasset, NY 11030-3876

Mailing address

38 Mayfield LN
Valley Stream, NY 11581-1618
Phone (516) 472-1404

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200316000945 NY Practitioner - Physician Assistant 5092143552 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divinity Medical Services PLLCGroup PAC ID 5193030245, 92 clinicians

Practice addresses (Care Compare)

1585 Dutch Broadway
Valley Stream, NY 11580-1333
Phone (516) 490-6300

1613 Westchester Ave
Bronx, NY 10472-2914
Phone (718) 571-9407

2128 Rockaway Pkwy
Brooklyn, NY 11236-5802
Phone (718) 489-8820

3379 Crompond Rd
Yorktown Heights, NY 10598-3605
Phone (914) 930-5550

3400 Boston Rd
Bronx, NY 10469-2502
Phone (718) 290-8787

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
023931NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jan 15, 2020 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Dec 4, 2025 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Dec 4, 2025 Accepting new patients

Locations

2248 31st St
Astoria, NY 11105
Phone (718) 267-1333

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

1613 Westchester Ave
Bronx, NY 10472
Phone (718) 571-9407

300 Community Dr
Manhasset, NY 11030

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

972 Brush Hollow Rd
Westbury, NY 11590

Interoperability endpoints

  • Direct secure messaging: ali.imran.1@2983.direct.athenahealth.com

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1083269120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 MAYFIELD LN",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811618",
            "telephone_number": "516-472-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303876",
            "telephone_number": "516-562-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMRAN",
        "first_name": "ALI",
        "middle_name": "N/A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-06",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.