Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00354600 | NJ |
NPI | 1073894226 |
---|---|
Provider Name | Mrs. Pushpa Sibi Abraham |
First Address | New Brunswick, NJ 08901-1942 |
Second Address | Charlottesville, VA 22901-1379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2011 |
Last Update Date | 26/07/2018 |