Healthcare Provider Details

I. General information

NPI: 1831081918
Provider Name (Legal Business Name): MOHAMED H YIMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E 81ST ST APT 1B
NEW YORK NY
10028-5808
US

IV. Provider business mailing address

417 E 81ST ST APT 1B
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 516-456-5708
  • Fax:
Mailing address:
  • Phone: 516-456-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: