Healthcare Provider Details

I. General information

NPI: 1972116804
Provider Name (Legal Business Name): MAYA MARIE ABRAHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYA MARIE WERKSMAN FNP

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVE STE G400
CENTRAL SQUARE NY
13036-2611
US

IV. Provider business mailing address

61 DELANO ST
PULASKI NY
13142-1400
US

V. Phone/Fax

Practice location:
  • Phone: 315-675-9200
  • Fax: 315-630-3168
Mailing address:
  • Phone: 315-298-6564
  • Fax: 315-298-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346156-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: