Healthcare Provider Details

I. General information

NPI: 1184327298
Provider Name (Legal Business Name): AHMED KLOBOCISTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

IV. Provider business mailing address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

V. Phone/Fax

Practice location:
  • Phone: 201-418-1000
  • Fax:
Mailing address:
  • Phone: 201-418-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA13218800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: