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General NPI Number Information
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NPI Number | 1114094711
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Entity Type | Individual
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Provider Name | AHMED MIRZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 666 PLAINSBORO RD SUITE 1318
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City | PLAINSBORO
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State | NJ
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Zip | 08536-3030
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Country | US
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Telephone | 732-266-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 5 SANIBEL CT
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-5816
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Country | US
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Telephone | 732-266-3733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 25MA07123000
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License Number State | NJ
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