1154441723 NPI number — JAMES V ABRAHAM

Table of content: (NPI 1154441723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154441723 NPI number — JAMES V ABRAHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES V ABRAHAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154441723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 GREGORY AVE
Provider Second Line Business Mailing Address:
UNIT 301
Provider Business Mailing Address City Name:
PASSAIC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07055-4856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-777-8121
Provider Business Mailing Address Fax Number:
973-777-3622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 GREGORY AVE
Provider Second Line Business Practice Location Address:
UNIT 301
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-777-8121
Provider Business Practice Location Address Fax Number:
973-777-3622
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABRAHAM
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
V
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
973-777-8121

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA05604700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 25MA05604700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 25MA05604700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: 25MA05604700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 97794 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2596704 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3838451-002 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000347100 . This is a "AMERICHOICE-INT. MED." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3838451-003 . This is a "CIGNA-PULMONARY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000347101 . This is a "AMERICHOICE-PULMONARY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000347102 . This is a "AMERICHOICE-CRITICAL CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4123649B . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1948961 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23J392 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7149036 . This is a "AETNA - CRITICAL CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2023783 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 02176169000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2681928 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7489901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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