Provider Demographics
NPI:1831623115
Name:AHMED, SUMIYA
Entity type:Individual
Prefix:
First Name:SUMIYA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2467
Mailing Address - Country:US
Mailing Address - Phone:732-666-8637
Mailing Address - Fax:
Practice Address - Street 1:23203 COLUMBUS RD STE I
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1985
Practice Address - Country:US
Practice Address - Phone:609-303-4450
Practice Address - Fax:609-303-4451
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10884900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program