Healthcare Provider Details

I. General information

NPI: 1003203704
Provider Name (Legal Business Name): SHABAZ AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GARDEN STATE PLZ
PARAMUS NJ
07652-2417
US

IV. Provider business mailing address

1 GARDEN STATE PLZ
PARAMUS NJ
07652-2417
US

V. Phone/Fax

Practice location:
  • Phone: 207-270-4588
  • Fax: 207-270-4589
Mailing address:
  • Phone: 207-270-4588
  • Fax: 207-270-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11246500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: