Provider Demographics
NPI:1548338411
Name:ABRAHAM, IRWIN (MD)
Entity type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 97TH ST STE 1G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6001
Mailing Address - Country:US
Mailing Address - Phone:212-726-9066
Mailing Address - Fax:212-726-9066
Practice Address - Street 1:50 W 97TH ST STE 1G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6001
Practice Address - Country:US
Practice Address - Phone:212-726-9066
Practice Address - Fax:212-726-9066
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118740207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1895SV1Medicare ID - Type Unspecified
NYD01588Medicare UPIN