Provider Demographics
NPI:1689732257
Name:AHMED, MAHBUB (MD)
Entity Type:Individual
Prefix:
First Name:MAHBUB
Middle Name:
Last Name:AHMED
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 1:518 MCDONALD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3870
Mailing Address - Country:US
Mailing Address - Phone:917-652-4627
Mailing Address - Fax:917-652-4629
Practice Address - Street 1:518 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3870
Practice Address - Country:US
Practice Address - Phone:917-652-4627
Practice Address - Fax:917-652-4629
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000327OtherMEDICARE NGS(QUEENS)
NY02063647Medicaid
NY06489Medicare ID - Type Unspecified
NYG300000327OtherMEDICARE NGS(QUEENS)
NY30N471Medicare ID - Type Unspecified