Healthcare Provider Details

I. General information

NPI: 1548338411
Provider Name (Legal Business Name): IRWIN ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 97TH ST STE 1G
NEW YORK NY
10025-6001
US

IV. Provider business mailing address

50 W 97TH ST STE 1G
NEW YORK NY
10025-6001
US

V. Phone/Fax

Practice location:
  • Phone: 212-726-9066
  • Fax: 212-726-9066
Mailing address:
  • Phone: 212-726-9066
  • Fax: 212-726-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number118740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: