Provider Demographics
NPI:1265449334
Name:AHKAMI, ROSALINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALINE
Middle Name:A
Last Name:AHKAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-471-1989
Mailing Address - Fax:
Practice Address - Street 1:122 MT BETHEL RD STE 1
Practice Address - Street 2:WARREN DERMATOLOGY ASSOCIATES LLC
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059
Practice Address - Country:US
Practice Address - Phone:908-756-7999
Practice Address - Fax:908-756-8017
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064016207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025782P67Medicare ID - Type Unspecified
G89520Medicare UPIN