Provider Demographics
NPI:1679682892
Name:ABRAHAM, MANOJ TIMOTHY (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:TIMOTHY
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1721
Mailing Address - Country:US
Mailing Address - Phone:845-454-8025
Mailing Address - Fax:845-454-8026
Practice Address - Street 1:82 N WATER ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1721
Practice Address - Country:US
Practice Address - Phone:845-454-8025
Practice Address - Fax:845-454-8026
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211519207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405489Medicaid
NYH66925Medicare UPIN
NY7M1901Medicare ID - Type Unspecified