Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT202013 | PA |
N | 111NI0900X | Internist | MT202013 | PA |
Y | 207RR0500X | Rheumatology | 290534 | NY |
NPI | 1073876199 |
---|---|
Provider Name | Mary Abraham |
First Address | New York, NY 10003-3804 |
Second Address | New York, NY 10003-3804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 01/08/2017 |