Provider Demographics
NPI:1538597166
Name:ABRAHAM, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2803
Mailing Address - Country:US
Mailing Address - Phone:201-339-1119
Mailing Address - Fax:201-339-1149
Practice Address - Street 1:690 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2803
Practice Address - Country:US
Practice Address - Phone:201-339-1119
Practice Address - Fax:201-339-1149
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ196143207Q00000X
NJ25MB09783000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine