MEDICARE: YVETTE R ABRAHAM 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	207L00000X	Anesthesiology Physician	209053	NY
2	208VP0014X	Interventional Pain Medicine Physician	209053	NY

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	:	1568406452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE R ABRAHAM MD

Provider Business Mailing Address
First Line	:	5 OAKWOOD CT
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1753
Country	:	US
Telephone Number	:	917-414-0617
Fax Number	:	732-847-3062

Provider Business Practice Location Address
First Line	:	3930 RICHMOND AVE
Second Line	:	SUITE101
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-5104
Country	:	US
Telephone Number	:	718-296-6131
Fax Number	:	732-847-3062

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/24/2014

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