Healthcare Provider Details

I. General information

NPI: 1710907308
Provider Name (Legal Business Name): SHIJA ABAHAM D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N ROUTE 73
WEST BERLIN NJ
08091-9242
US

IV. Provider business mailing address

55 FOXCROFT WAY
MOUNT LAUREL NJ
08054-5733
US

V. Phone/Fax

Practice location:
  • Phone: 856-768-1156
  • Fax: 856-768-1157
Mailing address:
  • Phone: 856-768-1156
  • Fax: 856-768-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00631900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: