Basic Information
| Provider Information | |||||||||
| NPI: | 1043216948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | IMRAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127013210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453336500 | ||||||||
| FaxNumber: | 8453336501 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127013210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453336500 | ||||||||
| FaxNumber: | 8453336501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 193608 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1272374 | 01 | NY | EMPIRE UNITED HC | OTHER | 01494999 | 05 | NY | MEDICAID |