Healthcare Provider Details

I. General information

NPI: 1578475075
Provider Name (Legal Business Name): REHAN AHMED AGPCNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MANCHESTER WAY
BURLINGTON NJ
08016-4300
US

IV. Provider business mailing address

45 MANCHESTER WAY
BURLINGTON NJ
08016-4300
US

V. Phone/Fax

Practice location:
  • Phone: 929-461-6388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15661000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: