Provider Demographics
NPI:1265672919
Name:ABRHA, KAHSAY HAILESELASSIE
Entity Type:Individual
Prefix:
First Name:KAHSAY
Middle Name:HAILESELASSIE
Last Name:ABRHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904-1034
Mailing Address - Country:US
Mailing Address - Phone:203-981-1948
Mailing Address - Fax:
Practice Address - Street 1:787 KING ST NURSIG HOME,RYE BROOK
Practice Address - Street 2:
Practice Address - City:PORTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-937-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263947-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse