Healthcare Provider Details

I. General information

NPI: 1194354399
Provider Name (Legal Business Name): TINU ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-5400
US

IV. Provider business mailing address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-5400
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6637
  • Fax:
Mailing address:
  • Phone: 516-572-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA187252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: