Healthcare Provider Details

I. General information

NPI: 1104403880
Provider Name (Legal Business Name): YORAM EBRAHIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W 168TH ST
NEW YORK NY
10032-3726
US

IV. Provider business mailing address

710 W 168TH ST
NEW YORK NY
10032-3726
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4888
  • Fax: 860-679-0134
Mailing address:
  • Phone: 877-426-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number335264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: