Provider Demographics
NPI:1457317844
Name:AMEEN, ABDUL A (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:A
Last Name:AMEEN
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 446
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07303-0446
Mailing Address - Country:US
Mailing Address - Phone:201-200-0318
Mailing Address - Fax:201-200-0319
Practice Address - Street 1:377 JERSEY AVE STE 410
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4397
Practice Address - Country:US
Practice Address - Phone:201-200-0318
Practice Address - Fax:201-200-0319
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069555207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8043001Medicaid
NJ8043001Medicaid
NJ031721Medicare ID - Type Unspecified