Provider Demographics
NPI:1679529234
Name:HAMMAD, AMJAD M (MD)
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:M
Last Name:HAMMAD
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 1:658 MALTA AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4105
Mailing Address - Country:US
Mailing Address - Phone:518-580-0553
Mailing Address - Fax:518-580-0557
Practice Address - Street 1:658 MALTA AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4105
Practice Address - Country:US
Practice Address - Phone:518-580-0553
Practice Address - Fax:518-580-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235752174400000X
NY235752-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654539Medicaid
NYH21922Medicare UPIN
NY02654539Medicaid