Imtiaz Ahmed, M.D.
Individual provider Active NPI Neonatal-Perinatal Medicine Physician · Long Branch, NJ
NPI 1164837241 · NPPES record last updated Feb 26, 2020
Key facts
- NPI
- 1164837241
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neonatal-Perinatal Medicine Physician 2080N0001X
- License
- 0442734 (KS)
- Practice address
- 300 2ND Ave
Long Branch, NJ 07740-6303 - Phone
- (610) 400-5782
- NPI assigned
- Jun 26, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171115001505 | PA | Order and Referring Only - Pediatric Medicine |
7113283714 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0442734 | KS | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Topeka Hospital, LLC | Past | Accepting new patients | |
| Stormont-Vail Healthcare Inc | Past | Accepting new patients |
Interoperability endpoints
- iahmed289247@ahs.direct-ci.com
- iahmed694699@direct.bmhcc.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD461387 | PA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 0442734 | KS | Yes |
Addresses
Primary practice location
300 2ND Ave
Long Branch, NJ 07740-6303
Mailing address
400 Sairs Ave
Long Branch, NJ 07740-5683
Phone (610) 400-5782
Other providers in Long Branch, NJ
- Acutecare Health System, LLC
- Alyse Adamo
- Advocates in Action
- Shailesh Aggarwal
- Manali Bharatkumar Agrawal
- Jay Ahn
- Micky Akinrodoye
- Ahmad Shaker Alalwan
- Albert Rienzo MD PA
- Usama Ali
All providers in Long Branch, NJ · Neonatal-Perinatal Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.