Individual
DR. IMTIAZ AHMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
308 WILLOW AVE., HOBOKEN, NJ 07030-3808
(201) 418-1420
(201) 418-1983
Mailing address
4567 CROSSROADS PARK DRIVE, LIVERPOOL, NY 13088-3589
(315) 295-2100
(201) 454-0136
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MA03908600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3626202
—
NJ
Enumeration date
12/05/2006
Last updated
03/02/2009
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