Provider Demographics
NPI:1730305699
Name:AHMED, MOHAMED HASSAN
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:HASSAN
Last Name:AHMED
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 1:554 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3307
Mailing Address - Country:US
Mailing Address - Phone:973-703-8202
Mailing Address - Fax:973-259-1315
Practice Address - Street 1:554 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 3D
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-703-8202
Practice Address - Fax:973-259-1315
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7650205Medicaid