MEDICARE: SHABAZ AHMED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA11246500	NJ

General Provider Information

NPI Number	:	1003203704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHABAZ AHMED M.D.

Provider Business Mailing Address
First Line	:	1 GARDEN STATE PLZ
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2417
Country	:	US
Telephone Number	:	207-270-4588
Fax Number	:	207-270-4589

Provider Business Practice Location Address
First Line	:	1 GARDEN STATE PLZ
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2417
Country	:	US
Telephone Number	:	207-270-4588
Fax Number	:	207-270-4589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	01/06/2026

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