Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 25MA07123000 | NJ |
NPI | 1114094711 |
---|---|
Provider Name | Dr. Ahmed Mirza |
First Address | Monroe Township, NJ 08831-5816 |
Second Address | Plainsboro, NJ 08536-3030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014940 | (05) | NJ |
H10639 | (02) | NJ |