Provider Demographics
NPI:1215959457
Name:AHMAD, REHAN (DO)
Entity type:Individual
Prefix:DR
First Name:REHAN
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5159 ROUTE 9W
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1452
Mailing Address - Country:US
Mailing Address - Phone:845-567-5972
Mailing Address - Fax:845-561-7063
Practice Address - Street 1:5159 ROUTE 9W
Practice Address - Street 2:SUITE B
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1452
Practice Address - Country:US
Practice Address - Phone:845-561-5972
Practice Address - Fax:845-561-7063
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231245207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02584150Medicaid
NY02584150Medicaid
NY3X5131Medicare PIN