Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MB09906000 | NJ |
NPI | 1457645707 |
---|---|
Provider Name | Mena Abrahim |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Bridgewater, NJ 08807-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2011 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MB09906000 | LICENSE # (01) | NJ |