Healthcare Provider Details

I. General information

NPI: 1114508306
Provider Name (Legal Business Name): BABY P ABRAHAM REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS WAY
PARAMUS NJ
07652-4100
US

IV. Provider business mailing address

605 MONROE AVE
TOWNSHIP OF WASHINGTON NJ
07676-4312
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-8581
  • Fax:
Mailing address:
  • Phone: 201-398-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number26NR13611900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: