Provider Demographics
NPI:1295885374
Name:ADAM, ABDALLA I (MD)
Entity type:Individual
Prefix:DR
First Name:ABDALLA
Middle Name:I
Last Name:ADAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:326 BERNARD DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2220
Mailing Address - Country:US
Mailing Address - Phone:718-207-4348
Mailing Address - Fax:833-843-8438
Practice Address - Street 1:16059 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5133
Practice Address - Country:US
Practice Address - Phone:718-207-4348
Practice Address - Fax:833-843-8438
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY241981208100000X, 2081P2900X
VA0101236767208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine