Individual
DR. IDREES AHMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
187 MILLBURN AVE, MILLBURN, NJ 07041-1847
(973) 467-1466
Mailing address
187 MILLBURN AVE, MILLBURN, NJ 07041-1847
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
25MA04153300
NJ
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
25MA04153300
NJ
208VP0000X
Pain Medicine Physician
25MA04153300
NJ
208VP0014X
Interventional Pain Medicine Physician
25MA04153300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430340TZG
MEDICARE
NJ
05
—
4969103
—
NJ
Enumeration date
08/31/2006
Last updated
03/26/2009
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