Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401413810 | VA |
N | 1223E0200X | Endodontist | 057629 | NY |
Y | 1223E0200X | Endodontist | 22DI02611500 | NJ |
N | 1223E0200X | Endodontist | DN19663 | FL |
NPI | 1114295771 |
---|---|
Provider Name | Ferdous Ahmed Ali |
First Address | Jersey City, NJ 07302-7587 |
Second Address | Montville, NJ 07045-9441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2011 |
Last Update Date | 01/10/2015 |