Provider Demographics
NPI:1033431853
Name:AHAMED, KHABIR UDDIN
Entity Type:Individual
Prefix:
First Name:KHABIR
Middle Name:UDDIN
Last Name:AHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6940
Mailing Address - Country:US
Mailing Address - Phone:718-455-7100
Mailing Address - Fax:
Practice Address - Street 1:103 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6940
Practice Address - Country:US
Practice Address - Phone:718-455-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037901-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01362789Medicaid