Provider Demographics
NPI:1336135656
Name:DARDEIR, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:DARDEIR
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 1:124 ASHWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4904
Mailing Address - Country:US
Mailing Address - Phone:917-202-1555
Mailing Address - Fax:718-494-4969
Practice Address - Street 1:34 RAMSEY LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5195
Practice Address - Country:US
Practice Address - Phone:718-494-4969
Practice Address - Fax:718-494-4969
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022859225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist