Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 225100000X | Physical Therapist | 40QA01589100 | NJ |
NPI | 1003208182 |
---|---|
Provider Name | Shady Ahmed |
First Address | South River, NJ 08882-2712 |
Second Address | New York, NY 10032-3733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2015 |
Last Update Date | 23/06/2020 |