Healthcare Provider Details

I. General information

NPI: 1215676242
Provider Name (Legal Business Name): JOEL THOMAS ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE
ASTORIA NY
11102-2448
US

IV. Provider business mailing address

PO BOX 28082
NEW YORK NY
10087-8082
US

V. Phone/Fax

Practice location:
  • Phone: 718-267-4262
  • Fax:
Mailing address:
  • Phone: 212-987-3100
  • Fax: 212-876-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10079469
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number341909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: