1891982880 NPI number — IQBAL AHMAD, MD LLC

Table of content: (NPI 1891982880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891982880 NPI number — IQBAL AHMAD, MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IQBAL AHMAD, MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891982880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 ACADEMY ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07102-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-643-5900
Provider Business Mailing Address Fax Number:
973-643-3171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 ACADEMY ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-643-5900
Provider Business Practice Location Address Fax Number:
973-643-3171
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAGAN
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
973-643-5900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  26455 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4979401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108356 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1100092 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MI000012001 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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