Healthcare Provider Details

I. General information

NPI: 1588540371
Provider Name (Legal Business Name): AMY ABRAHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-8862
  • Fax: 718-226-8586
Mailing address:
  • Phone: 718-226-8862
  • Fax: 718-226-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF356297-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: