Provider Demographics
NPI:1144425232
Name:MOHAMED AHMED PHYSICIANS PC
Entity Type:Organization
Organization Name:MOHAMED AHMED PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BESSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:315-598-5921
Mailing Address - Street 1:941 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4989
Mailing Address - Country:US
Mailing Address - Phone:315-598-5921
Mailing Address - Fax:315-598-5921
Practice Address - Street 1:941 S 1ST ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4989
Practice Address - Country:US
Practice Address - Phone:315-598-5921
Practice Address - Fax:315-598-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188122261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY188122OtherLIC.
NY01299825Medicaid
NYAA1155Medicare PIN
NYDD0933Medicare UPIN