Provider Demographics
NPI:1063175727
Name:MOHAMED S AHMED
Entity type:Organization
Organization Name:MOHAMED S AHMED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:SAID
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-425-8647
Mailing Address - Street 1:2931 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1251
Mailing Address - Country:US
Mailing Address - Phone:716-425-8647
Mailing Address - Fax:716-356-8197
Practice Address - Street 1:2931 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1251
Practice Address - Country:US
Practice Address - Phone:716-425-8647
Practice Address - Fax:716-356-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247436-01OtherSTATE OF NEW YORK EDUCATION DEPARTMENT