Provider Demographics
NPI:1104992718
Name:ABRAHAM, OSCAR (LAC, LMT)
Entity type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3607
Mailing Address - Country:US
Mailing Address - Phone:718-258-1829
Mailing Address - Fax:718-677-9485
Practice Address - Street 1:955 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3607
Practice Address - Country:US
Practice Address - Phone:718-258-1829
Practice Address - Fax:718-677-9485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003995171100000X
NY012347225700000X
NJ25MZ00053400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist