Basic Information
Provider Information
NPI: 1316994437
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AHSAN
FirstName: ABU
MiddleName: M.
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 FEDERAL ST STE SW200
Address2:  
City: CAMDEN
State: NJ
PostalCode: 081031155
CountryCode: US
TelephoneNumber: 8563564924
FaxNumber: 8563564710
Practice Location
Address1: 1 COOPER PLZ
Address2:  
City: CAMDEN
State: NJ
PostalCode: 08103
CountryCode: US
TelephoneNumber: 8563423150
FaxNumber: 8569688418
Other Information
ProviderEnumerationDate: 05/27/2006
LastUpdateDate: 05/31/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMA062709NJN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XMA062709NJY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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