Healthcare Provider Details

I. General information

NPI: 1679842835
Provider Name (Legal Business Name): AHMED ABDELRAHIM MOHAMED ABOUMOHAMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

1250 WATERS PL
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 646-640-7867
  • Fax:
Mailing address:
  • Phone: 646-640-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number288801
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number288801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: