Provider Demographics
NPI:1356751838
Name:AHMED, AMEER NIZAM (MD)
Entity type:Individual
Prefix:
First Name:AMEER
Middle Name:NIZAM
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 1:2317 CENTER ISLAND ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:201-354-1951
Mailing Address - Fax:
Practice Address - Street 1:82 LAMBERTS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7210
Practice Address - Country:US
Practice Address - Phone:718-477-5479
Practice Address - Fax:718-761-1770
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301612207RS0010X
NJ25MA10398000207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine