Basic Information
| Provider Information | |||||||||
| NPI: | 1811022940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHSAN | ||||||||
| FirstName: | AMBREEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 LB#7550 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191957550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 ROUTE 46 UNIT 34-36 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070461668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737943170 | ||||||||
| FaxNumber: | 9737747033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA 07861600 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.