Provider Demographics
NPI:1528203676
Name:AHMAD, SAIRA (MD)
Entity Type:Individual
Prefix:
First Name:SAIRA
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 AVENEL ST
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1281
Mailing Address - Country:US
Mailing Address - Phone:732-750-1180
Mailing Address - Fax:732-750-1147
Practice Address - Street 1:415 AVENEL ST
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1281
Practice Address - Country:US
Practice Address - Phone:732-750-1180
Practice Address - Fax:732-750-1147
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08985200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0443999Medicaid