Provider Demographics
NPI:1144423013
Name:IVAN P. ABRAHAMSON & HAL F. ABRAHAMSON, ADVANCED FOOTCARE ASSOC.
Entity Type:Organization
Organization Name:IVAN P. ABRAHAMSON & HAL F. ABRAHAMSON, ADVANCED FOOTCARE ASSOC.
Other - Org Name:AADVANCED FOOTCARE ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-896-4433
Mailing Address - Street 1:9707 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1641
Mailing Address - Country:US
Mailing Address - Phone:718-896-4433
Mailing Address - Fax:718-896-4747
Practice Address - Street 1:9707 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1641
Practice Address - Country:US
Practice Address - Phone:718-896-4433
Practice Address - Fax:718-896-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002007213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0526630001Medicare NSC
NY30891BMedicare PIN