Provider Demographics
NPI:1982830329
Name:AHMED, SUBHAN (MD)
Entity Type:Individual
Prefix:
First Name:SUBHAN
Middle Name:
Last Name:AHMED
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 1:870 PALISADE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3445
Mailing Address - Country:US
Mailing Address - Phone:201-836-0897
Mailing Address - Fax:201-836-8042
Practice Address - Street 1:870 PALISADE AVE STE 202
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3445
Practice Address - Country:US
Practice Address - Phone:201-836-0897
Practice Address - Fax:201-836-8042
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10425800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349279502Medicaid
TX349279502Medicaid