Healthcare Provider Details

I. General information

NPI: 1316467988
Provider Name (Legal Business Name): ENS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 54TH ST APT 11A
NEW YORK NY
10019-5535
US

IV. Provider business mailing address

205 W 54TH ST APT 11A
NEW YORK NY
10019-5535
US

V. Phone/Fax

Practice location:
  • Phone: 917-574-5334
  • Fax:
Mailing address:
  • Phone: 917-574-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number240578
License Number StateNY

VIII. Authorized Official

Name: OMAR F AHMED
Title or Position: MD
Credential: MD
Phone: 917-574-5334