Provider Demographics
NPI:1275570509
Name:AHMAD, YASIR J (MD)
Entity Type:Individual
Prefix:DR
First Name:YASIR
Middle Name:J
Last Name:AHMAD
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 1:79 OGLE ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7026
Mailing Address - Country:US
Mailing Address - Phone:201-490-5158
Mailing Address - Fax:201-696-3955
Practice Address - Street 1:300A FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5429
Practice Address - Country:US
Practice Address - Phone:201-490-5158
Practice Address - Fax:201-696-3955
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076582002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI21002Medicare UPIN
NJ085236Medicare ID - Type Unspecified