Provider Demographics
NPI:1366042053
Name:AHMED, IMAN M
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:M
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHERBA PL
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1941
Mailing Address - Country:US
Mailing Address - Phone:973-563-8360
Mailing Address - Fax:
Practice Address - Street 1:383 WASHINGTON
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642
Practice Address - Country:US
Practice Address - Phone:201-664-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04123800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist