Healthcare Provider Details

I. General information

NPI: 1932120615
Provider Name (Legal Business Name): SUJOOD AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

IV. Provider business mailing address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-4064
  • Fax: 609-272-8526
Mailing address:
  • Phone: 609-646-4064
  • Fax: 609-272-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA07887000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: