Provider Demographics
NPI:1184243040
Name:PCR PHYSICIAN PLLC
Entity type:Organization
Organization Name:PCR PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-222-1198
Mailing Address - Street 1:117 GREENWAY W
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2226
Mailing Address - Country:US
Mailing Address - Phone:909-757-8314
Mailing Address - Fax:
Practice Address - Street 1:117 GREENWAY W
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2226
Practice Address - Country:US
Practice Address - Phone:909-757-8314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04607627Medicaid
NJ0669423Medicaid