Provider Demographics
NPI:1922184720
Name:ABRAHAM, JENNY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:ELIZABETH
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4920
Mailing Address - Country:US
Mailing Address - Phone:631-661-6202
Mailing Address - Fax:631-661-7269
Practice Address - Street 1:725 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4920
Practice Address - Country:US
Practice Address - Phone:631-661-6202
Practice Address - Fax:631-661-7269
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046862-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02645581Medicaid