MEDICARE: DR. SAMOON AHMAD 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	2084P0800X	Psychiatry Physician	205637	NY

General Provider Information

NPI Number	:	1649333691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMOON AHMAD M.D.

Provider Business Mailing Address
First Line	:	381 PARK AVE S
Second Line	:	SUITE 620
City	:	NEW YORK
State	:	NY
Zip	:	10016-8806
Country	:	US
Telephone Number	:	212-585-1111
Fax Number	:	212-562-8541

Provider Business Practice Location Address
First Line	:	381 PARK AVE S
Second Line	:	SUITE 620
City	:	NEW YORK
State	:	NY
Zip	:	10016-8806
Country	:	US
Telephone Number	:	212-585-1111
Fax Number	:	212-562-8541

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/11/2015

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