Healthcare Provider Details

I. General information

NPI: 1043216948
Provider Name (Legal Business Name): IMRAN AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CONCORD RD
MONTICELLO NY
12701-3210
US

IV. Provider business mailing address

38 CONCORD RD
MONTICELLO NY
12701-3210
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-6500
  • Fax: 845-333-6501
Mailing address:
  • Phone: 845-333-6500
  • Fax: 845-333-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number193608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: