Provider Demographics
NPI:1760492250
Name:AHMAD, MEJDI (MD)
Entity Type:Individual
Prefix:
First Name:MEJDI
Middle Name:
Last Name:AHMAD
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 1:775 PARK AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3976
Mailing Address - Country:US
Mailing Address - Phone:631-659-4150
Mailing Address - Fax:631-659-4199
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-659-4150
Practice Address - Fax:631-659-4199
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204245-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199544Medicaid
NY015AP2OtherBLUE CROSS/ BLUE SHIELD
NY2595081OtherGHI
NY4C0571OtherHEALTHNET
NYP2470796OtherOXFORD
NY4C0571OtherHEALTHNET
NY646K61Medicare ID - Type Unspecified