Provider Demographics
NPI:1730198854
Name:HAJ-IBRAHIM, AHMAD (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:HAJ-IBRAHIM
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 1:691 DELAWARE AVE
Mailing Address - Street 2:PO BOX 301
Mailing Address - City:ROEBLING
Mailing Address - State:NJ
Mailing Address - Zip Code:08554-2001
Mailing Address - Country:US
Mailing Address - Phone:609-499-8100
Mailing Address - Fax:609-499-8118
Practice Address - Street 1:691 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ROEBLING
Practice Address - State:NJ
Practice Address - Zip Code:08554-2001
Practice Address - Country:US
Practice Address - Phone:609-499-8100
Practice Address - Fax:609-499-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06520400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2194303OtherOXFORD HEALTH PLAN
1139647OtherUNITED HEALTHCARE
223630266001OtherTRICARE
4637401OtherAETNA
0264674000OtherAMERIHEALTH HMO
5634087OtherFIRST HEALTH NETWORK
NJ8169004Medicaid
000628307001OtherGREAT WEST
7365832OtherCIGNA
1139647OtherAARP
2171226OtherAETNA PPO
2K4971OtherHEALTHNET
NJ8169004Medicaid
1139647OtherUNITED HEALTHCARE