1033354220 NPI number — FEBA ABRAHAM

Table of content: FEBA ABRAHAM (NPI 1033354220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033354220 NPI number — FEBA ABRAHAM

Organization/Personal Information

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

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:
1033354220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WHITTIER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBERTSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11507-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-626-9481
Provider Business Mailing Address Fax Number:
718-206-6915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 VAN WYCK EXPY
Provider Second Line Business Practice Location Address:
JAMAICA HOSPITAL
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11418-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-206-6000
Provider Business Practice Location Address Fax Number:
718-206-6915
Provider Enumeration Date:
12/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  F 350147 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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