Provider Demographics
NPI:1104871466
Name:ABRAMO, CHARLES (L M T)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:ABRAMO
Suffix:
Gender:M
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LUDLAM RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4531
Mailing Address - Country:US
Mailing Address - Phone:914-213-0166
Mailing Address - Fax:845-781-7916
Practice Address - Street 1:1019 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1643
Practice Address - Country:US
Practice Address - Phone:914-213-0166
Practice Address - Fax:845-781-7916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist