Healthcare Provider Details

I. General information

NPI: 1043204068
Provider Name (Legal Business Name): ABRAHAM JELIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-6277
  • Fax: 718-250-6856
Mailing address:
  • Phone: 718-250-6277
  • Fax: 718-250-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number116569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: