Provider Demographics
NPI:1285735860
Name:AHMAD, MIR M (MD)
Entity type:Individual
Prefix:
First Name:MIR
Middle Name:M
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 HOP BROOK LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2143
Mailing Address - Country:US
Mailing Address - Phone:908-912-4561
Mailing Address - Fax:908-603-0191
Practice Address - Street 1:83 HANOVER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-736-2212
Practice Address - Fax:973-736-2989
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06784300174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8336105Medicaid
NJ035354A4GMedicare ID - Type Unspecified
NJ8336105Medicaid