Provider Demographics
NPI:1336350131
Name:EBRAHIM, AMBER (MD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:EBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FIRST AVENUE AT 16TH STREET
Mailing Address - Street 2:PATHOLOGY DEPT.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-420-2124
Mailing Address - Fax:212-420-3449
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-420-2124
Practice Address - Fax:212-420-3449
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243536207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02879041Medicaid
NY016RA70Medicare PIN