Basic Information
| Provider Information | |||||||||
| NPI: | 1013147131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMAD | ||||||||
| FirstName: | AMBREEN | ||||||||
| MiddleName: | SHARIQ | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 N WARREN ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086184741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092785900 | ||||||||
| FaxNumber: | 6093961526 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 EWING ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086091004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092785900 | ||||||||
| FaxNumber: | 6093961526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08443700 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.