MEDICARE: DR. AVRAHAM ABBOUDI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	047100	NY

General Provider Information

NPI Number	:	1063537421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVRAHAM ABBOUDI DMD

Provider Business Mailing Address
First Line	:	1108 SUSSEX RD
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-2729
Country	:	US
Telephone Number	:	201-692-1072
Fax Number	:	732-875-1622

Provider Business Practice Location Address
First Line	:	3595 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3410
Country	:	US
Telephone Number	:	718-356-1450
Fax Number	:	718-356-1756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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