Individual provider · NPI-1

Tracy Ivan Abraham, PA

Physician Assistant, Surgical · Bronx, NY

NPI number1124241872
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1124241872
Entity type
Individual (NPI-1)
Name
Tracy Ivan Abraham
Credential
PA
Sex
Male
Sole proprietor
Yes
Enumeration date
Apr 11, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AS0400X Physician Assistant, Surgical006753-1NYYes

Practice location

1650 Grand Concourse
Bronx, NY 10457

Phone 718-901-8484

Mailing address

187 N. Brookside Ave.
Freeport, NY 11520-1928

Phone 516-546-2980

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