Fakhiuddin Ahmed, M.D.
Individual provider Active NPI Hematology & Oncology Physician · Great Neck, NY
NPI 1770514622 · NPPES record last updated Oct 17, 2011
Key facts
- NPI
- 1770514622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- 116505 (NY)
- Practice address
- 11 Mirrielees Cir
Great Neck, NY 11021-2926 - Phone
- (516) 487-2366
- Fax
- (516) 487-2058
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116505 | NY | MD | Hematology & Oncology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 116505 | NY | Yes |
Addresses
Primary practice location
11 Mirrielees Cir
Great Neck, NY 11021-2926
Mailing address
11 Mirrielees Cir
Great Neck, NY 11021-2926
Phone (516) 487-2366
NPI Registry JSON
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1770514622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 MIRRIELEES CIR",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212926",
"telephone_number": "516-487-2366",
"fax_number": "516-487-2058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 MIRRIELEES CIR",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212926",
"telephone_number": "516-487-2366",
"fax_number": "516-487-2058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMED",
"first_name": "FAKHIUDDIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "NY",
"license": "116505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.