Basic Information
| Provider Information | |||||||||
| NPI: | 1093953614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | MARIAMMA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | R.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 372 HAROLD ST | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103144147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186987749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2324 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103031506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184470200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | 292641-1 | NY | Y | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.