Provider Demographics
NPI:1871154682
Name:ABDELMONEM, AHMED (PA-C)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABDELMONEM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2794
Mailing Address - Country:US
Mailing Address - Phone:917-657-8020
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE # F4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:718-818-9739
Practice Address - Fax:973-926-2997
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00552300363A00000X, 207T00000X
NY024401363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical