Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101243802 | VA |
N | 208600000X | Surgeon | 0101243802 | VA |
N | 208200000X | Surgeon | 25MA08635100 | NJ |
N | 208600000X | Surgeon | 25MA08635100 | NJ |
Y | 2086S0102X | Surgical Critical Care | 25MA08635100 | NJ |
NPI | 1104015056 |
---|---|
Provider Name | Hesham Ahmed |
First Address | Tinton Falls, NJ 07701-4947 |
Second Address | New Brunswick, NJ 08901-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0217433 | (05) | NJ |
P00953260 | RR MCR PTAN (01) | NJ |