Provider Demographics
NPI:1114307113
Name:ABASS, MARYAM (BSC)
Entity Type:Individual
Prefix:MISS
First Name:MARYAM
Middle Name:
Last Name:ABASS
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107
Mailing Address - Country:US
Mailing Address - Phone:973-573-8287
Mailing Address - Fax:
Practice Address - Street 1:331 CENTRAL AVE
Practice Address - Street 2:1
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2407
Practice Address - Country:US
Practice Address - Phone:973-673-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00656300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist