Cyrus Ahmadi, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

MA032935 Issued in NJ

Practice address

53 Passaic Ave
Passaic, NJ 07055-4801

Phone

(973) 471-4440

Fax

(973) 471-4681

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 28, 2010.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285632000000",
    "number": "1912901950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 PASSAIC AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554801",
            "telephone_number": "973-471-4440",
            "fax_number": "973-471-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 PASSAIC AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554801",
            "telephone_number": "973-471-4440",
            "fax_number": "973-471-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHMADI",
        "first_name": "CYRUS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2010-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NJ",
            "license": "MA032935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0101202001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY",
            "identifier": "1035326",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4330670",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "PPQ15",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USA",
            "identifier": "298253",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "441625",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GUARDIAN",
            "identifier": "C64487370",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "QK974Q",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10509",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0375004",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICHOICE",
            "identifier": "23178",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "01000004300",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID (UNISYS)",
            "identifier": "0375004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5318425004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "667685",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US HEALTH",
            "identifier": "11073(2534)",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOCAL 734",
            "identifier": "19981288",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY",
            "identifier": "12708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Passaic, NJ
• Pediatric Adolescent Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.