1770312209 NPI number — FIRM FOUNDATION COUNSELING LLC

Table of content: OMAR FAROOQ AHMAD MD (NPI 1093715310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770312209 NPI number — FIRM FOUNDATION COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRM FOUNDATION COUNSELING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770312209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 ROGERS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CRANE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13833-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-205-5756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 US-11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-203-1593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
TOWERS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
607-862-6092

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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