Healthcare Provider Details

I. General information

NPI: 1437310240
Provider Name (Legal Business Name): JACOB KURIAKOSE ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE DEPT OF ANESTHESIA
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

PO BOX 630
FRANKLIN LAKES NJ
07417-0630
US

V. Phone/Fax

Practice location:
  • Phone: 201-847-9320
  • Fax:
Mailing address:
  • Phone: 201-847-9320
  • Fax: 201-847-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number270360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: