Provider Demographics
NPI:1407924210
Name:EVIATAR, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:EVIATAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 WILLIAMSBRIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-822-1103
Mailing Address - Fax:718-597-1799
Practice Address - Street 1:1578 WILLIAMSBRIDGE RD.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-822-1103
Practice Address - Fax:718-597-1799
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103442207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GS210OtherOXFORD
103442OtherHIP
NY00179520Medicaid
B15784Medicare UPIN
512811Medicare ID - Type Unspecified
GS210OtherOXFORD