Provider Demographics
NPI:1316742828
Name:AHMED, WAQAR
Entity type:Individual
Prefix:
First Name:WAQAR
Middle Name:
Last Name:AHMED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 PARKER AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6927
Mailing Address - Country:US
Mailing Address - Phone:201-461-4646
Mailing Address - Fax:201-461-4655
Practice Address - Street 1:1622 PARKER AVE STE 1A
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6927
Practice Address - Country:US
Practice Address - Phone:201-461-4646
Practice Address - Fax:201-461-4655
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS00748100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1861859092Medicaid