Provider Demographics
NPI:1669422523
Name:AHMED, SYED IMRAN (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:IMRAN
Last Name:AHMED
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:PO BOX 720507
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-0507
Mailing Address - Country:US
Mailing Address - Phone:917-364-0801
Mailing Address - Fax:516-746-0831
Practice Address - Street 1:1651 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1846
Practice Address - Country:US
Practice Address - Phone:917-364-0801
Practice Address - Fax:516-629-6258
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234776208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02667681Medicaid
NY4373H1Medicare ID - Type Unspecified
NYI28517Medicare UPIN