Provider Demographics
NPI:1467974949
Name:DAMATI, AHMAD MOHAMMAD TAWFIQ (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:MOHAMMAD TAWFIQ
Last Name:DAMATI
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 1:250 CENTRAL AVE APT 116
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-4202
Mailing Address - Country:US
Mailing Address - Phone:312-468-9712
Mailing Address - Fax:
Practice Address - Street 1:123 UNIVERSITY AVE, NEWARK, NJ 07102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-854-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program