Healthcare Provider Details

I. General information

NPI: 1487984175
Provider Name (Legal Business Name): JAMIL M. ABRAHAM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131-24 ROCKAWAY BLVD
SO OZONE PARK NY
11420
US

IV. Provider business mailing address

131-24 ROCKAWAY BLVD
SO OZONE PARK NY
11420
US

V. Phone/Fax

Practice location:
  • Phone: 718-659-7166
  • Fax: 718-529-5930
Mailing address:
  • Phone: 718-659-7166
  • Fax: 718-529-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number107354
License Number StateNY

VIII. Authorized Official

Name: DR. JAMIL M ABRAHAM
Title or Position: MD
Credential: MD
Phone: 718-659-7166