Provider Demographics
NPI:1962548404
Name:ABITTAN, ABRAHAM I (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:I
Last Name:ABITTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1242
Mailing Address - Country:US
Mailing Address - Phone:516-295-3838
Mailing Address - Fax:516-295-4976
Practice Address - Street 1:1122 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1242
Practice Address - Country:US
Practice Address - Phone:516-295-3838
Practice Address - Fax:516-295-4976
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY66K021Medicare ID - Type Unspecified
66K022Medicare ID - Type Unspecified
NYF38814Medicare UPIN