Healthcare Provider Details

I. General information

NPI: 1205323623
Provider Name (Legal Business Name): AMMAR QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

67780 E PALM CANYON DR
CATHEDRAL CITY CA
92234-5441
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-2770
  • Fax: 732-897-3970
Mailing address:
  • Phone: 760-837-8993
  • Fax: 760-837-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA173561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA173561
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA12743600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: