Provider Demographics
NPI:1588410856
Name:ILAHI, AHMED MUSTAFA (OD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MUSTAFA
Last Name:ILAHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8005
Mailing Address - Country:US
Mailing Address - Phone:212-938-4000
Mailing Address - Fax:212-938-4000
Practice Address - Street 1:4504 46TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1702
Practice Address - Country:US
Practice Address - Phone:718-493-2020
Practice Address - Fax:718-493-2020
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist