Provider Demographics
NPI:1255409751
Name:AHMED, AMINA A
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:A
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMINA
Other - Middle Name:A
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2440 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1914
Mailing Address - Country:US
Mailing Address - Phone:201-433-3316
Mailing Address - Fax:201-433-4448
Practice Address - Street 1:2440 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1914
Practice Address - Country:US
Practice Address - Phone:201-433-3316
Practice Address - Fax:201-433-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08159800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0134171Medicaid
NJ0134171Medicaid
NJ111865Medicare PIN