Provider Demographics
NPI:1275902587
Name:ABRAMS, JENNIFER (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ABRAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:31 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2220
Mailing Address - Country:US
Mailing Address - Phone:631-924-4411
Mailing Address - Fax:631-924-4454
Practice Address - Street 1:31 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2220
Practice Address - Country:US
Practice Address - Phone:631-924-4411
Practice Address - Fax:631-924-4454
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577795-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33-4013Medicare PIN