Healthcare Provider Details

I. General information

NPI: 1568406452
Provider Name (Legal Business Name): YVETTE R ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVETTE R ABRAHAM MD

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 RICHMOND AVE SUITE101
STATEN ISLAND NY
10312-5104
US

IV. Provider business mailing address

5 OAKWOOD CT
HOLMDEL NJ
07733-1753
US

V. Phone/Fax

Practice location:
  • Phone: 718-296-6131
  • Fax: 732-847-3062
Mailing address:
  • Phone: 917-414-0617
  • Fax: 732-847-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number209053
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number209053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: