NPIMap

Individual provider Active NPI

Intikhab Ahmad

  • Psychiatry Physician
  • Staten Island, NY
National Provider Identifier
1710008693
Registry record updated Dec 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
238270 Issued in NY
Practice address
308 Seaview Ave
Staten Island, NY 10305-2246
Phone
(718) 351-1717
Fax
(718) 667-8893
NPI assigned
Apr 2, 2007
Last updated
Dec 29, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 238270 NY Primary

Addresses

Primary practice location

308 Seaview Ave
Staten Island, NY 10305-2246

Mailing address

308 Seaview Ave
Staten Island, NY 10305-2246
Phone (718) 351-1717

Other identifiers 1

IdentifierTypeStateIssuer
238270MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110923000255 NY Practitioner - Psychiatry 9830360833 Reassigns benefits to 1 organization
Practice locations: Staten Island, NY
I20230907003632 NJ Practitioner - Psychiatry 9830360833 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Azz Medical Associates PCGroup PAC ID 6002132685, 63 clinicians

Practice addresses (Care Compare)

100 Sullivan Way
Trenton, NJ 08625-0500
Phone (609) 633-1562

1440 Pennington Rd
Suite 1
Ewing, NJ 08618-2669

2279 Route 33
Suite 505
Hamilton, NJ 08690-1750
Phone (609) 890-1050

308 Seaview Ave
Staten Island, NY 10305-2246
Phone 718351171721

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
238270NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of New Jersey Omb Centralized Payroll CurrentSince May 25, 2023 Accepting new patients
Arise Child and Family Service Inc CurrentSince Apr 22, 2016 Accepting new patients
State of New Jersey Omb Centralized Payroll CurrentSince May 25, 2023 Accepting new patients
Richmond Psychological Services, P.C. Past Accepting new patients
Logan-Mingo Area Mental Health, Inc Past Accepting new patients
Clinical Management Consultants Psychiatry Past Accepting new patients

Locations

635 James St
Syracuse, NY 13203
Phone (315) 472-3171

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Trenton Psychiatric HospitalWest Trenton, NJ, CCN 314013 Hospital Corporate Director
W-2 Managing Employee		 Jan 1, 2019
Jan 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451347200000",
    "number": "1710008693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103052246",
            "telephone_number": "718-351-1717",
            "fax_number": "718-667-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103052246",
            "telephone_number": "718-351-1717",
            "fax_number": "718-667-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHMAD",
        "first_name": "INTIKHAB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2015-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "238270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "238270",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.