Provider Demographics
NPI:1912901950
Name:AHMADI, CYRUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:AHMADI
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 1:53 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4801
Mailing Address - Country:US
Mailing Address - Phone:973-471-4440
Mailing Address - Fax:973-471-4681
Practice Address - Street 1:53 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4801
Practice Address - Country:US
Practice Address - Phone:973-471-4440
Practice Address - Fax:973-471-4681
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0329352080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101202001OtherAMERIHEALTH
1035326OtherMERCY
4330670OtherAETNA
PPQ15OtherOXFORD
298253OtherUSA
441625OtherKEYSTONE
C64487370OtherGUARDIAN
QK974QOtherHEALTHNET
10509OtherAMERIGROUP
NJ0375004Medicaid
23178OtherMEDICHOICE
01000004300OtherAMERICHOICE
0375004OtherMEDICAID (UNISYS)
5318425004OtherCIGNA
667685OtherFIRST HEALTH
11073(2534)OtherUS HEALTH
19981288OtherLOCAL 734
12708OtherUNIVERSITY
PPQ15OtherOXFORD
NJAH441625Medicare ID - Type Unspecified