Healthcare Provider Details

I. General information

NPI: 1609711563
Provider Name (Legal Business Name): MOHAMED MOHAMED AHMED MHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SOUTH AVE STE 4B
STATEN ISLAND NY
10303-1512
US

IV. Provider business mailing address

420 SOUTH AVE STE 4B
STATEN ISLAND NY
10303-1512
US

V. Phone/Fax

Practice location:
  • Phone: 347-881-3407
  • Fax: 718-816-0048
Mailing address:
  • Phone: 347-881-3407
  • Fax: 718-816-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: