Healthcare Provider Details

I. General information

NPI: 1235790023
Provider Name (Legal Business Name): AHMAD FAHMI ALHAMMADA STUDENT IN AN ORGANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVENUE
NEW YORK NY
10037
US

IV. Provider business mailing address

506 LENOX AVENUE
NEW YORK NY
10037
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-4019
  • Fax:
Mailing address:
  • Phone: 971-506-3280
  • Fax: 971-650-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: