Healthcare Provider Details

I. General information

NPI: 1134526692
Provider Name (Legal Business Name): JESSIE ABRAHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HILLSIDE AVENUE SUITE #103
NEW HYDE PARK NY
11040-2501
US

IV. Provider business mailing address

1575 HILLSIDE AVENUE SUITE #103
NEW HYDE PARK NY
11040-2501
US

V. Phone/Fax

Practice location:
  • Phone: 516-352-1804
  • Fax: 516-352-1449
Mailing address:
  • Phone: 516-352-1804
  • Fax: 516-352-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338934-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: