Provider Demographics
NPI:1396712790
Name:MASOOD, AHMAD (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:MASOOD
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 1:815 BLOOMING GROVE TPKE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8135
Mailing Address - Country:US
Mailing Address - Phone:845-569-8600
Mailing Address - Fax:845-569-8788
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209460207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01719295Medicaid
NYG38100Medicare UPIN
NY28U902Medicare ID - Type Unspecified
NY01719295Medicaid