Healthcare Provider Details

I. General information

NPI: 1891982880
Provider Name (Legal Business Name): IQBAL AHMAD, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ACADEMY ST SUITE 203
NEWARK NJ
07102-2924
US

IV. Provider business mailing address

45 ACADEMY ST SUITE 203
NEWARK NJ
07102-2924
US

V. Phone/Fax

Practice location:
  • Phone: 973-643-5900
  • Fax: 973-643-3171
Mailing address:
  • Phone: 973-643-5900
  • Fax: 973-643-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26455
License Number StateNJ

VIII. Authorized Official

Name: MRS. JOANN PAGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-643-5900