MEDICARE: DR. AHMED DARDEIR MD

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	208D00000X	General Practice Physician	0101287615	VA
2	225100000X	Physical Therapist	022859	NY

General Provider Information

NPI Number	:	1336135656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED DARDEIR MD

Provider Business Mailing Address
First Line	:	124 ASHWORTH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4904
Country	:	US
Telephone Number	:	917-202-1555
Fax Number	:	718-494-4969

Provider Business Practice Location Address
First Line	:	40 HUNT CLUB BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2274
Country	:	US
Telephone Number	:	757-825-2425
Fax Number	:

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	12/09/2025

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