Provider Demographics
NPI:1790950335
Name:THOMAS J. ABRAHAMSEN
Entity Type:Organization
Organization Name:THOMAS J. ABRAHAMSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABRAHAMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-226-9430
Mailing Address - Street 1:129 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2438
Mailing Address - Country:US
Mailing Address - Phone:203-226-9430
Mailing Address - Fax:
Practice Address - Street 1:129 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2438
Practice Address - Country:US
Practice Address - Phone:203-226-9430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000417213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0706020001Medicare NSC