1912901950 NPI number — DR. CYRUS AHMADI MD

Table of content: DR. CYRUS AHMADI MD (NPI 1912901950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912901950 NPI number — DR. CYRUS AHMADI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMADI
Provider First Name:
CYRUS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912901950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 PASSAIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASSAIC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07055-4801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-471-4440
Provider Business Mailing Address Fax Number:
973-471-4681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 PASSAIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-471-4440
Provider Business Practice Location Address Fax Number:
973-471-4681
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  MA032935 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0101202001 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1035326 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4330670 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PPQ15 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 298253 . This is a "USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 441625 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C64487370 . This is a "GUARDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: QK974Q . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10509 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0375004 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23178 . This is a "MEDICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000004300 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0375004 . This is a "MEDICAID (UNISYS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5318425004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 667685 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11073(2534) . This is a "US HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19981288 . This is a "LOCAL 734" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12708 . This is a "UNIVERSITY" identifier . This identifiers is of the category "OTHER".




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