Provider Demographics
NPI:1255796439
Name:UNION MEDICAL PRACTICE PC
Entity type:Organization
Organization Name:UNION MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAUZIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-925-9100
Mailing Address - Street 1:42 FLINTLOCK CT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2108
Mailing Address - Country:US
Mailing Address - Phone:908-766-0071
Mailing Address - Fax:908-766-0071
Practice Address - Street 1:822 N WOOD AVE
Practice Address - Street 2:3RD FLOOR SUITE 102
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4000
Practice Address - Country:US
Practice Address - Phone:908-925-9100
Practice Address - Fax:908-925-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07075900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty