Provider Demographics
NPI:1013147131
Name:SAMAD, AMBREEN SHARIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBREEN
Middle Name:SHARIQ
Last Name:SAMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N WARREN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4741
Mailing Address - Country:US
Mailing Address - Phone:609-278-5900
Mailing Address - Fax:609-396-1526
Practice Address - Street 1:112 EWING ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1004
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:609-396-1526
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08443700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics