MEDICARE: DR. ISRAR A ABBASI MD

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	2084P0800X	Psychiatry Physician	MD071694L	PA
2	2084P0800X	Psychiatry Physician	254621	NY
3	2084P0804X	Child & Adolescent Psychiatry Physician	254621	NY
4	2084P0804X	Child & Adolescent Psychiatry Physician	MD071694L	PA
5	2084P0804X	Child & Adolescent Psychiatry Physician	036098579	IL
6	2084P0800X	Psychiatry Physician	036098579	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518925437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISRAR A ABBASI MD

Provider Business Mailing Address
First Line	:	305 E FAIRMOUNT AVE
Second Line	:
City	:	LAKEWOOD
State	:	NY
Zip	:	14750-2000
Country	:	US
Telephone Number	:	716-526-4041
Fax Number	:	716-526-4161

Provider Business Practice Location Address
First Line	:	305 E FAIRMOUNT AVE
Second Line	:
City	:	LAKEWOOD
State	:	NY
Zip	:	14750
Country	:	US
Telephone Number	:	716-526-4041
Fax Number	:	716-526-4161

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/08/2019

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