Provider Demographics
NPI:1568406452
Name:ABRAHAM, YVETTE R (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:R
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:R
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5 OAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1753
Mailing Address - Country:US
Mailing Address - Phone:917-414-0617
Mailing Address - Fax:732-847-3062
Practice Address - Street 1:3930 RICHMOND AVE
Practice Address - Street 2:SUITE101
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5104
Practice Address - Country:US
Practice Address - Phone:718-296-6131
Practice Address - Fax:732-847-3062
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209053207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01817770Medicaid
G68764Medicare UPIN
NY01817770Medicaid