Healthcare Provider Details

I. General information

NPI: 1396056065
Provider Name (Legal Business Name): IMRAN AHMED JAMIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 HAMBURG TPKE STE 209
WAYNE NJ
07470-2069
US

IV. Provider business mailing address

340 MERCER LOOP
JERSEY CITY NJ
07302-3233
US

V. Phone/Fax

Practice location:
  • Phone: 973-720-9300
  • Fax: 201-335-0835
Mailing address:
  • Phone: 646-379-5927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number274118
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09550500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: