Provider Demographics
NPI:1568442424
Name:ABRAHAM, THANAA NELLY KHALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:THANAA NELLY
Middle Name:KHALIL
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882H COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6430
Mailing Address - Country:US
Mailing Address - Phone:732-818-0808
Mailing Address - Fax:732-818-1112
Practice Address - Street 1:882H COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6430
Practice Address - Country:US
Practice Address - Phone:732-818-0808
Practice Address - Fax:732-818-1112
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07219300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8678201Medicaid
NJ8678201Medicaid
NJ088041, 051720 TUXMedicare PIN