Provider Demographics
NPI:1083729917
Name:AHAD, ANTWAN (MD)
Entity Type:Individual
Prefix:
First Name:ANTWAN
Middle Name:
Last Name:AHAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 PATERSON PLANK RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3242
Mailing Address - Country:US
Mailing Address - Phone:201-863-6101
Mailing Address - Fax:201-863-7777
Practice Address - Street 1:1265 PATERSON PLANK RD
Practice Address - Street 2:SUITE 3E
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3242
Practice Address - Country:US
Practice Address - Phone:201-863-6101
Practice Address - Fax:201-863-7777
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062269002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7560508Medicaid
G63928Medicare UPIN
NJAB005252Medicare ID - Type Unspecified