Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 211519 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | 211519 | NY |
NPI | 1679682892 |
---|---|
Provider Name | Dr. Manoj Timothy Abraham |
First Address | Poughkeepsie, NY 12601-1721 |
Second Address | Poughkeepsie, NY 12601-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02405489 | (05) | NY |
H66925 | (02) | NY |