Provider Demographics
NPI:1962529388
Name:AHMAD, AHSANUDDIN
Entity type:Individual
Prefix:DR
First Name:AHSANUDDIN
Middle Name:
Last Name:AHMAD
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 1:120 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2326
Mailing Address - Country:US
Mailing Address - Phone:845-565-4400
Mailing Address - Fax:
Practice Address - Street 1:120 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2326
Practice Address - Country:US
Practice Address - Phone:201-216-9791
Practice Address - Fax:201-216-1362
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09621100207RC0000X, 207RC0001X
NY269175207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0483982Medicaid
NJ448382PPVMedicare PIN