Provider Demographics
NPI:1699922856
Name:KAZMI, SYED IFTIKHAR AHMED (MD)
Entity type:Individual
Prefix:
First Name:SYED IFTIKHAR
Middle Name:AHMED
Last Name:KAZMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-3015
Mailing Address - Country:US
Mailing Address - Phone:973-615-1433
Mailing Address - Fax:
Practice Address - Street 1:176 PALISADE AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-795-8200
Practice Address - Fax:732-212-0713
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08431900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0179027Medicaid
NJ139637YC3LMedicare PIN