=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114561487
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YASMIN AHMAD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2019
-----------------------------------------------------
Last Update Date | 10/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 671 HOES LN W
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-235-5720
-----------------------------------------------------
Fax | 732-235-4841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 578 RIVA AVE
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-4759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-940-0787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 349092
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------