MEDICARE: AHMED GOLAM HAIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	222682	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154407310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMED GOLAM HAIDER

Provider Business Mailing Address
First Line	:	125 PAGE RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3448
Country	:	US
Telephone Number	:	917-634-9445
Fax Number	:	917-634-9444

Provider Business Practice Location Address
First Line	:	1466 SAINT PETERS AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3304
Country	:	US
Telephone Number	:	917-634-9445
Fax Number	:	971-634-9444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	12/17/2015

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Directions to “ AHMED GOLAM HAIDER ” Practice Location

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