Provider Demographics
NPI:1609272871
Name:ABUBAKAR, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:ABUBAKAR
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 1:96 PARKWAY
Mailing Address - Street 2:BUILDING B
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4200
Mailing Address - Country:US
Mailing Address - Phone:201-291-1010
Mailing Address - Fax:201-368-9228
Practice Address - Street 1:96 PARKWAY
Practice Address - Street 2:BUILDING B
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4200
Practice Address - Country:US
Practice Address - Phone:201-291-1010
Practice Address - Fax:201-368-9228
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09599600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0471968Medicaid
NJ428319YFDXMedicare PIN