Provider Demographics
NPI:1609260595
Name:ABRAHAM, GEORGE (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 N MAIN ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1412
Mailing Address - Country:US
Mailing Address - Phone:201-719-0701
Mailing Address - Fax:
Practice Address - Street 1:1420 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-9130
Practice Address - Country:US
Practice Address - Phone:856-875-0100
Practice Address - Fax:856-629-4619
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00779300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist