Provider Demographics
NPI:1992039002
Name:ABRAHAM, LEELAMMA
Entity Type:Individual
Prefix:
First Name:LEELAMMA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4628
Mailing Address - Country:US
Mailing Address - Phone:201-262-1249
Mailing Address - Fax:
Practice Address - Street 1:27 S FRANKLIN TPKE
Practice Address - Street 2:PREVENTIVE&DIAGNOSTIC MEDICAL SUITE 201
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2550
Practice Address - Country:US
Practice Address - Phone:201-818-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00248200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health