Provider Demographics
NPI:1811201007
Name:ABRAHAM, CHARLENE NAOMI (NP)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:NAOMI
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2306
Mailing Address - Country:US
Mailing Address - Phone:718-842-8040
Mailing Address - Fax:718-842-8394
Practice Address - Street 1:1055 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2306
Practice Address - Country:US
Practice Address - Phone:718-842-8040
Practice Address - Fax:718-842-8394
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily