Healthcare Provider Details

I. General information

NPI: 1972505626
Provider Name (Legal Business Name): HAL FREDRIC ABRAHAMSON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 63RD RD
REGO PARK NY
11374-1641
US

IV. Provider business mailing address

9707 63RD RD
REGO PARK NY
11374-1641
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-4433
  • Fax: 718-896-4747
Mailing address:
  • Phone: 718-896-4433
  • Fax: 718-896-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004608
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: