Provider Demographics
NPI:1750350120
Name:AHMAD, FUAD (MD)
Entity type:Individual
Prefix:DR
First Name:FUAD
Middle Name:
Last Name:AHMAD
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 1:191 HAMBURG TPKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2330
Mailing Address - Country:US
Mailing Address - Phone:973-831-6557
Mailing Address - Fax:973-831-6552
Practice Address - Street 1:191 HAMBURG TPKE
Practice Address - Street 2:SUITE 2
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2330
Practice Address - Country:US
Practice Address - Phone:973-831-6557
Practice Address - Fax:973-831-6552
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7024100Medicaid
NJ574172Medicare ID - Type Unspecified
NJG41502Medicare UPIN