Healthcare Provider Details

I. General information

NPI: 1154441723
Provider Name (Legal Business Name): JAMES V ABRAHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 GREGORY AVE UNIT 301
PASSAIC NJ
07055-4856
US

IV. Provider business mailing address

124 GREGORY AVE UNIT 301
PASSAIC NJ
07055-4856
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-8121
  • Fax: 973-777-3622
Mailing address:
  • Phone: 973-777-8121
  • Fax: 973-777-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05604700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA05604700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA05604700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA05604700
License Number StateNJ

VIII. Authorized Official

Name: DR. JAMES V ABRAHAM
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 973-777-8121