Provider Demographics
NPI:1417517509
Name:EZZELDEN, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:EZZELDEN
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:
Practice Address - Street 1:435 SOUTH ST STE 350
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6474
Practice Address - Country:US
Practice Address - Phone:973-971-6700
Practice Address - Fax:973-290-7480
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11446300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine