Provider Demographics
NPI:1649261454
Name:ACKAD, ALEXANDRE S (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRE
Middle Name:S
Last Name:ACKAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-447-0013
Mailing Address - Fax:201-447-0438
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-447-0013
Practice Address - Fax:201-447-0438
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2012-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA2626300207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0609901Medicaid
NJ130586BLBMedicare PIN
NJ0609901Medicaid