Provider Demographics
NPI:1265471999
Name:THANAA NELLY KHALIL ABRAHAM PC
Entity Type:Organization
Organization Name:THANAA NELLY KHALIL ABRAHAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANAA NELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-818-0808
Mailing Address - Street 1:882 H COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6430
Mailing Address - Country:US
Mailing Address - Phone:732-818-0808
Mailing Address - Fax:
Practice Address - Street 1:882 H COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6430
Practice Address - Country:US
Practice Address - Phone:732-818-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07219300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8678201Medicaid
NJ8678201Medicaid
NJ088041Medicare PIN