Provider Demographics
NPI:1598458135
Name:EID, AHMED (LSW)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:EID
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2724
Mailing Address - Country:US
Mailing Address - Phone:201-660-2978
Mailing Address - Fax:
Practice Address - Street 1:640 EAGLE ROCK AVE STE 1
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2931
Practice Address - Country:US
Practice Address - Phone:862-930-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06948200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker