Healthcare Provider Details

I. General information

NPI: 1528701828
Provider Name (Legal Business Name): RYAN ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 30TH AVE
ASTORIA NY
11102-2448
US

IV. Provider business mailing address

2520 30TH AVE
ASTORIA NY
11102-2448
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-1000
  • Fax:
Mailing address:
  • Phone: 718-932-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number342105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: