Healthcare Provider Details

I. General information

NPI: 1497955603
Provider Name (Legal Business Name): SAJI ABRAHAM M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 FRANCIS LEWIS BLVD SUITE L3A
BAYSIDE NY
11361-3028
US

IV. Provider business mailing address

4401 FRANCIS LEWIS BLVD SUITE L3A
BAYSIDE NY
11361-3028
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-3355
  • Fax: 718-423-3721
Mailing address:
  • Phone: 718-423-3355
  • Fax: 718-423-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number236583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: