Healthcare Provider Details

I. General information

NPI: 1174450134
Provider Name (Legal Business Name): POLARIS FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24028 128TH AVE
ROSEDALE NY
11422-1002
US

IV. Provider business mailing address

24028 128TH AVE
ROSEDALE NY
11422-1002
US

V. Phone/Fax

Practice location:
  • Phone: 347-962-0907
  • Fax:
Mailing address:
  • Phone: 347-962-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEHINDE OLUDOTUN
Title or Position: PRESIDENT
Credential:
Phone: 347-962-0907