Provider Demographics
NPI:1528017696
Name:ABRAMSON, JERROLD H
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:H
Last Name:ABRAMSON
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 1:60 NORTHGATE CIR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3041
Mailing Address - Country:US
Mailing Address - Phone:631-241-3848
Mailing Address - Fax:631-479-1986
Practice Address - Street 1:60 NORTHGATE CIR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3041
Practice Address - Country:US
Practice Address - Phone:631-241-3848
Practice Address - Fax:631-479-1986
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006531-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006531OtherHIP HEALTH PLAN OF NY
NYAA46654OtherMDNY HEALTHCARE
NY00580850Medicaid
NY039235OtherVALUEOPTIONS
NYCS172OtherOXFORD HEALTH PLANS
NY0010830OtherGHI
NY039235OtherVYTRA HEALTHCARE
NY1000045953OtherBEACON HEALTH STRATEGIES
NYCS172OtherOXFORD HEALTH PLANS
NY1000045953OtherBEACON HEALTH STRATEGIES