Provider Demographics
NPI:1285003996
Name:AHMED, ISMAIL (LPN)
Entity Type:Individual
Prefix:
First Name:ISMAIL
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 UNIVERSITY AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4406
Mailing Address - Country:US
Mailing Address - Phone:646-288-2909
Mailing Address - Fax:
Practice Address - Street 1:1800 UNIVERSITY AVE APT 3G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4445
Practice Address - Country:US
Practice Address - Phone:646-288-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse