Provider Demographics
NPI:1225201684
Name:ABBASSI AND AGRAMA P C
Entity type:Organization
Organization Name:ABBASSI AND AGRAMA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-669-0010
Mailing Address - Street 1:81 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5342
Mailing Address - Country:US
Mailing Address - Phone:973-669-0010
Mailing Address - Fax:973-736-8355
Practice Address - Street 1:81 NORTHFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5342
Practice Address - Country:US
Practice Address - Phone:973-669-0010
Practice Address - Fax:973-736-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA032490261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2102901Medicaid
NJC55814Medicare UPIN
NJ456499Medicare PIN