Provider Demographics
NPI:1598926909
Name:AHMED, SULTAN
Entity Type:Individual
Prefix:
First Name:SULTAN
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3109
Mailing Address - Country:US
Mailing Address - Phone:917-541-2919
Mailing Address - Fax:
Practice Address - Street 1:3728 77TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6630
Practice Address - Country:US
Practice Address - Phone:718-335-7378
Practice Address - Fax:718-335-1071
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598926909Medicaid