Provider Demographics
NPI:1518925437
Name:ABBASI, ISRAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:ISRAR
Middle Name:A
Last Name:ABBASI
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 1:305 E FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-2000
Mailing Address - Country:US
Mailing Address - Phone:716-526-4041
Mailing Address - Fax:716-526-4161
Practice Address - Street 1:305 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750
Practice Address - Country:US
Practice Address - Phone:716-526-4041
Practice Address - Fax:716-526-4161
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071694L2084P0800X, 2084P0804X
NY2546212084P0800X, 2084P0804X
IL0360985792084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01627449Medicaid
NYRB2501Medicare PIN
NYCC7755Medicare PIN
NYCC7754Medicare PIN
NY01627449Medicaid