Provider Demographics
NPI:1780883371
Name:ABAI, BABAK (MD)
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:ABAI
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 1:1300 WOLF ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2912
Mailing Address - Country:US
Mailing Address - Phone:215-551-0360
Mailing Address - Fax:
Practice Address - Street 1:1300 WOLF ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2912
Practice Address - Country:US
Practice Address - Phone:215-551-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08224200208600000X, 2086S0129X
PAMD4190702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2857379000OtherAMERIHEALTH/KEYSTONE
NJP3807778OtherOXFORD HEALTH PLAN
PA001943880Medicaid
NJ2802241OtherUNITED HEALTHCARE
NJ3K6562OtherHEALTHNET
NJ01007833100OtherAMERICHOICE
NJ6859760OtherCIGNA
NJ1599007OtherAETNA
NJ60033606OtherHORIZON NJ HEALTH
NJ0136913Medicaid
NJP00455958OtherRR MEDICARE
NJ3K6562OtherHEALTHNET
NJP00455958OtherRR MEDICARE