Provider Demographics
NPI:1104956697
Name:ABRAMS, ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 ALDERSHOT LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3705
Mailing Address - Country:US
Mailing Address - Phone:516-627-0530
Mailing Address - Fax:
Practice Address - Street 1:9438 59TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5151
Practice Address - Country:US
Practice Address - Phone:718-699-1100
Practice Address - Fax:718-699-1300
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02780376Medicaid