Provider Demographics
NPI:1699963942
Name:ABRAHAM, SHAJAN KOSHY (PT)
Entity type:Individual
Prefix:
First Name:SHAJAN
Middle Name:KOSHY
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1932
Mailing Address - Country:US
Mailing Address - Phone:914-512-0566
Mailing Address - Fax:
Practice Address - Street 1:581 OLD WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5079
Practice Address - Country:US
Practice Address - Phone:914-512-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029763225100000X
NY62P60043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist