Provider Demographics
NPI:1497955603
Name:ABRAHAM, SAJI (MBBS)
Entity Type:Individual
Prefix:
First Name:SAJI
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE L3A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3028
Mailing Address - Country:US
Mailing Address - Phone:718-423-3355
Mailing Address - Fax:718-423-3721
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE L3A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3028
Practice Address - Country:US
Practice Address - Phone:718-423-3355
Practice Address - Fax:718-423-3721
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236583207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02916136Medicaid
NY02916136Medicaid
NYG400089273Medicare PIN