Provider Demographics
NPI:1366935009
Name:AHMAT, SALAHADDI S
Entity type:Individual
Prefix:
First Name:SALAHADDI
Middle Name:S
Last Name:AHMAT
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 1:591 SUMMIT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2714
Mailing Address - Country:US
Mailing Address - Phone:201-890-4300
Mailing Address - Fax:201-706-2124
Practice Address - Street 1:591 SUMMIT AVE STE 201
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2714
Practice Address - Country:US
Practice Address - Phone:201-890-4300
Practice Address - Fax:201-706-2124
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ47-1617150Medicaid