Provider Demographics
NPI:1710008693
Name:AHMAD, INTIKHAB
Entity Type:Individual
Prefix:
First Name:INTIKHAB
Middle Name:
Last Name:AHMAD
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 1:308 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2246
Mailing Address - Country:US
Mailing Address - Phone:718-351-1717
Mailing Address - Fax:718-667-8893
Practice Address - Street 1:308 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2246
Practice Address - Country:US
Practice Address - Phone:718-351-1717
Practice Address - Fax:718-667-8893
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2382702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY238270Medicaid
NYH51005Medicare UPIN