Provider Demographics
NPI:1043217185
Name:AVRAHAM, ISAIA (MD)
Entity Type:Individual
Prefix:
First Name:ISAIA
Middle Name:
Last Name:AVRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 MAYFAIR DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6910
Mailing Address - Country:US
Mailing Address - Phone:718-209-5127
Mailing Address - Fax:718-209-5128
Practice Address - Street 1:433 MAYFAIR DR S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6910
Practice Address - Country:US
Practice Address - Phone:718-209-5127
Practice Address - Fax:718-209-5128
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188449207RI0200X
NJ25MA05396400207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01582943Medicaid
NY01582943Medicaid