Provider Demographics
NPI:1629520218
Name:AHMED, ABDUL-KHALIQ (LPN)
Entity Type:Individual
Prefix:
First Name:ABDUL-KHALIQ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2610 BEULAH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1011
Mailing Address - Country:US
Mailing Address - Phone:845-380-8346
Mailing Address - Fax:
Practice Address - Street 1:2610 BEULAH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1011
Practice Address - Country:US
Practice Address - Phone:845-380-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility