Healthcare Provider Details

I. General information

NPI: 1033641188
Provider Name (Legal Business Name): AMMAD ARIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY RM 4N98
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

2601 OCEAN PKWY RM 4N98
BROOKLYN NY
11235-7745
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3779
  • Fax:
Mailing address:
  • Phone: 718-616-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number309265
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number309265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: