Provider Demographics
NPI:1053517201
Name:STONY FORD FOUNDATION INC
Entity type:Organization
Organization Name:STONY FORD FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-703-5523
Mailing Address - Street 1:390 CRYSTAL RUN RD
Mailing Address - Street 2:SUIT 105
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941
Mailing Address - Country:US
Mailing Address - Phone:845-703-5523
Mailing Address - Fax:845-703-2970
Practice Address - Street 1:390 CRYSTAL RUN RD
Practice Address - Street 2:SUIT 105
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-703-5523
Practice Address - Fax:845-703-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01790945Medicaid
NY02008111Medicaid
NY02702087Medicaid
NY02751820Medicaid
NY01288944Medicaid
NY01387728Medicaid
NY02596610Medicaid
NY02004126Medicaid
NY02528187Medicaid
NY01489761Medicaid
NY02205801Medicaid