Provider Demographics
NPI:1225039464
Name:AHMADI, DAVID FARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FARD
Last Name:AHMADI
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 1:222 EASTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1723
Mailing Address - Country:US
Mailing Address - Phone:732-828-6404
Mailing Address - Fax:732-846-8035
Practice Address - Street 1:222 EASTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1723
Practice Address - Country:US
Practice Address - Phone:732-828-6404
Practice Address - Fax:732-846-8035
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03724500207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA03724500OtherMEDICAL LICENSE
C52755Medicare UPIN