Healthcare Provider Details

I. General information

NPI: 1588293054
Provider Name (Legal Business Name): AHMAD ABUGHARBIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARRISON ST STE 101
JOHNSON CITY NY
13790-2161
US

IV. Provider business mailing address

9500 EUCLID AVE # NA-23
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-8181
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number339194
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number339194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: