Provider Demographics
NPI:1760771547
Name:PATHAK, ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:PATHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1567 PALISADE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6923
Mailing Address - Country:US
Mailing Address - Phone:201-585-2388
Mailing Address - Fax:516-442-5945
Practice Address - Street 1:1567 PALISADE AVE FL 3
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6923
Practice Address - Country:US
Practice Address - Phone:201-585-2388
Practice Address - Fax:516-442-5945
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA114327002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery