Provider Demographics
NPI:1588741706
Name:AHMED, SULTAN
Entity type:Individual
Prefix:
First Name:SULTAN
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 HIGHLAND AVE
Mailing Address - Street 2:602
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3562
Mailing Address - Country:US
Mailing Address - Phone:718-658-8190
Mailing Address - Fax:212-533-8347
Practice Address - Street 1:159 RIVINGTON ST
Practice Address - Street 2:LINDEMANN PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2434
Practice Address - Country:US
Practice Address - Phone:212-254-2600
Practice Address - Fax:212-533-8347
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01378165Medicaid