Provider Demographics
NPI:1407915564
Name:AHAMED, JAHID (MD)
Entity Type:Individual
Prefix:
First Name:JAHID
Middle Name:
Last Name:AHAMED
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 1:55 GREENE AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6433
Mailing Address - Country:US
Mailing Address - Phone:718-783-3690
Mailing Address - Fax:718-783-5584
Practice Address - Street 1:55 GREENE AVENUE
Practice Address - Street 2:SUITE 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6433
Practice Address - Country:US
Practice Address - Phone:718-783-3690
Practice Address - Fax:718-783-5584
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY190011207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3V8851OtherBLUE CROSS BLUE SHIELD
NY01394701Medicaid
NY01394701Medicaid
WEP621Medicare ID - Type Unspecified
F40494Medicare UPIN