Provider Demographics
NPI:1972505626
Name:ABRAHAMSON, HAL FREDRIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:FREDRIC
Last Name:ABRAHAMSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1641
Mailing Address - Country:US
Mailing Address - Phone:718-896-4433
Mailing Address - Fax:718-896-4747
Practice Address - Street 1:9707 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1641
Practice Address - Country:US
Practice Address - Phone:718-896-4433
Practice Address - Fax:718-896-4747
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004608213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01470575Medicaid
NYP52032Medicare PIN
NY01470575Medicaid
NY63250AMedicare PIN