Provider Demographics
NPI:1922497114
Name:ABRAHAM, NOBLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NOBLE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2351
Mailing Address - Country:US
Mailing Address - Phone:718-844-5350
Mailing Address - Fax:718-390-0067
Practice Address - Street 1:4010 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-692-1155
Practice Address - Fax:718-390-0067
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038026-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist