Provider Demographics
NPI:1275825481
Name:AHMED, IRFAN (RVT, RPVI)
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:RVT, RPVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2920
Mailing Address - Country:US
Mailing Address - Phone:917-774-0098
Mailing Address - Fax:
Practice Address - Street 1:3857 KINGS HWY APT 6A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2920
Practice Address - Country:US
Practice Address - Phone:917-774-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
NY1392692471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
139269OtherARDMS
NYNX86579TMedicaid