Provider Demographics
NPI:1518750553
Name:ERNAZAROV, AKHMAD (DO)
Entity type:Individual
Prefix:
First Name:AKHMAD
Middle Name:
Last Name:ERNAZAROV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 ABITARE BLVD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2677
Mailing Address - Country:US
Mailing Address - Phone:201-450-3790
Mailing Address - Fax:
Practice Address - Street 1:7 S OHIO AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6711
Practice Address - Country:US
Practice Address - Phone:609-939-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program