Healthcare Provider Details

I. General information

NPI: 1982242020
Provider Name (Legal Business Name): SABBIR AHMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13719 LAFAYETTE ST FL 1
JAMAICA NY
11417-2701
US

IV. Provider business mailing address

13719 LAFAYETTE ST FL 1
JAMAICA NY
11417-2701
US

V. Phone/Fax

Practice location:
  • Phone: 347-553-2973
  • Fax:
Mailing address:
  • Phone: 347-553-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: