Provider Demographics
NPI:1912115023
Name:ABRAHAM, TONY (DO)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1500 ROUTE 112 BLDG 4
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8055
Mailing Address - Country:US
Mailing Address - Phone:631-751-3000
Mailing Address - Fax:315-096-5596
Practice Address - Street 1:1500 ROUTE 112 BLDG 2
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8055
Practice Address - Country:US
Practice Address - Phone:631-751-3000
Practice Address - Fax:631-509-6559
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2430512085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology