Provider Demographics
NPI:1982686457
Name:HADDAD, AHMAD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:JOHN
Last Name:HADDAD
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:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:370 HWY 35
Practice Address - Street 2:STE 101
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5922
Practice Address - Country:US
Practice Address - Phone:732-758-0048
Practice Address - Fax:732-758-0052
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67D161OtherEMPIRE BCBS
875522OtherAETNA HMO
NJ8484199OtherCIGNA HEALTHCARE
NJ0K4751OtherHEALTH NET
NJMP173OtherOXFORD HEALTH PLANS
NJ0312703Medicaid
NJMP173OtherOXFORD HEALTH PLANS
NJ0312703Medicaid