Provider Demographics
NPI:1558595900
Name:SUNIL ABRAHAM, MINI (PT)
Entity Type:Individual
Prefix:MISS
First Name:MINI
Middle Name:
Last Name:SUNIL ABRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 KROLL RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1608
Mailing Address - Country:US
Mailing Address - Phone:516-784-7497
Mailing Address - Fax:
Practice Address - Street 1:1704 KROLL RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1608
Practice Address - Country:US
Practice Address - Phone:516-784-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist