MEDICARE: MOINUDDIN AHMED

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	207RP1001X	Pulmonary Disease Physician	60211958	NY
2	207R00000X	Internal Medicine Physician	60211958	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255325346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOINUDDIN AHMED

Provider Business Mailing Address
First Line	:	123 PIKE ST
Second Line	:	SUITE 207
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1824
Country	:	US
Telephone Number	:	845-856-2244
Fax Number	:	845-856-1166

Provider Business Practice Location Address
First Line	:	123 PIKE ST
Second Line	:	SUITE 207
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1824
Country	:	US
Telephone Number	:	845-856-2244
Fax Number	:	845-856-1166

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	JUDY LANDERS
Credential	:
Telephone Number	:	845-856-2244

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	09/11/2025

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Directions to “MOINUDDIN AHMED ” Practice Location

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