Healthcare Provider Details

I. General information

NPI: 1548500408
Provider Name (Legal Business Name): HAMILTON BEHAVIORAL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300A FOREST AVE
PARAMUS NJ
07652-5429
US

IV. Provider business mailing address

79 OGLE RD
OLD TAPPAN NJ
07675-7026
US

V. Phone/Fax

Practice location:
  • Phone: 201-490-5158
  • Fax:
Mailing address:
  • Phone: 201-490-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMA07658200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. YASIR JAMAL AHMAD
Title or Position: PRESIDENT
Credential: MD
Phone: 201-490-5158