Healthcare Provider Details

I. General information

NPI: 1255409751
Provider Name (Legal Business Name): AMINA A AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMINA A AHMAD

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/02/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 VILLAGE ROAD SUITE 2
NEW VERNON NJ
07976
US

IV. Provider business mailing address

17 VILLAGE ROAD SUITE 2
NEW VERNON NJ
07976
US

V. Phone/Fax

Practice location:
  • Phone: 973-886-0457
  • Fax: 973-860-5423
Mailing address:
  • Phone: 973-886-0457
  • Fax: 973-860-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08159800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: