Provider Demographics
NPI:1417903360
Name:FUAD A AHMAD MD PA
Entity type:Organization
Organization Name:FUAD A AHMAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-831-6557
Mailing Address - Street 1:191 HAMBURG TPKE
Mailing Address - Street 2:STE 2
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2330
Mailing Address - Country:US
Mailing Address - Phone:973-831-6557
Mailing Address - Fax:973-831-6552
Practice Address - Street 1:191 HAMBURG TPKE
Practice Address - Street 2:STE 2
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2330
Practice Address - Country:US
Practice Address - Phone:973-831-6557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7024100Medicaid
NJ122429Medicare PIN
NJG41502Medicare UPIN