Provider Demographics
NPI:1952330490
Name:AHMED, WALEED (DPT)
Entity Type:Individual
Prefix:DR
First Name:WALEED
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:KIAMESHA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12751-0130
Mailing Address - Country:US
Mailing Address - Phone:845-796-2470
Mailing Address - Fax:845-796-1420
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-796-2470
Practice Address - Fax:845-796-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02622571Medicaid
NY02622571Medicaid