Provider Demographics
NPI:1386714491
Name:ABRAMS, STACY BETH (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:BETH
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 168 STREET
Mailing Address - Street 2:PH 1137 ASSOCIATES IN EMERGENCY SERVICES CUMC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3784
Mailing Address - Country:US
Mailing Address - Phone:212-305-2995
Mailing Address - Fax:212-305-6792
Practice Address - Street 1:622 W 168 STREET
Practice Address - Street 2:PH 1137 COLUMBIA UNIVERSITY MED CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3784
Practice Address - Country:US
Practice Address - Phone:212-305-2995
Practice Address - Fax:212-305-6792
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02644791Medicaid
NY5751L1Medicare ID - Type Unspecified
NY02644791Medicaid