Provider Demographics
NPI:1275042897
Name:CNY SOMALI COMMUNITY INC
Entity Type:Organization
Organization Name:CNY SOMALI COMMUNITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJO
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABDULKADIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-664-5392
Mailing Address - Street 1:804 N SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 N SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2513
Practice Address - Country:US
Practice Address - Phone:315-664-5392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)