MEDICARE: SUBHAN 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	207RN0300X	Nephrology Physician	25MA10425800	NJ

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	:	1982830329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUBHAN AHMED M.D

Provider Business Mailing Address
First Line	:	870 PALISADE AVE STE 202
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3445
Country	:	US
Telephone Number	:	201-836-0897
Fax Number	:	201-836-8042

Provider Business Practice Location Address
First Line	:	870 PALISADE AVE STE 202
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3445
Country	:	US
Telephone Number	:	201-836-0897
Fax Number	:	201-836-8042

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	06/24/2019

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