Provider Demographics
NPI:1902895238
Name:AHMAD, IJAZ (MD)
Entity Type:Individual
Prefix:
First Name:IJAZ
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:70 OLD WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1611
Mailing Address - Country:US
Mailing Address - Phone:646-338-4912
Mailing Address - Fax:718-857-8498
Practice Address - Street 1:47 PLAZA ST W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3905
Practice Address - Country:US
Practice Address - Phone:646-338-4912
Practice Address - Fax:718-865-9253
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2021-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY247775-1207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY321AU1Medicare PIN