Provider Demographics
NPI:1457435737
Name:TAHER, ABU (MD)
Entity Type:Individual
Prefix:DR
First Name:ABU
Middle Name:
Last Name:TAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HEYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2412
Mailing Address - Country:US
Mailing Address - Phone:917-687-8592
Mailing Address - Fax:718-339-8950
Practice Address - Street 1:634 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1821
Practice Address - Country:US
Practice Address - Phone:718-339-8950
Practice Address - Fax:718-339-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211161208100000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01879092Medicaid
NY01879092Medicaid
NYG79090Medicare UPIN