Provider Demographics
NPI:1891982880
Name:IQBAL AHMAD, MD LLC
Entity Type:Organization
Organization Name:IQBAL AHMAD, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-643-5900
Mailing Address - Street 1:45 ACADEMY ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2924
Mailing Address - Country:US
Mailing Address - Phone:973-643-5900
Mailing Address - Fax:973-643-3171
Practice Address - Street 1:45 ACADEMY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2924
Practice Address - Country:US
Practice Address - Phone:973-643-5900
Practice Address - Fax:973-643-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26455174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4979401Medicaid
NJ108356OtherAMERIGROUP
NJ1100092OtherHORIZON NJ HEALTH
NJMI000012001OtherAMERICHOICE
NJ=========OtherBLUECROSS BLUESHIELD
NJ=========OtherMAGNACARE
NJ=========OtherGHI
NJ4979401Medicaid