Provider Demographics
NPI:1255925699
Name:ALY, AMAL (MD, PHD)
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:ALY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROCKLEDGE TER
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1215
Mailing Address - Country:US
Mailing Address - Phone:917-453-3803
Mailing Address - Fax:
Practice Address - Street 1:25 RIVERSIDE DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9391
Practice Address - Country:US
Practice Address - Phone:888-599-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MS00020400207ZP0007X, 170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology