Jacqueline Abraham, DDS
Individual provider Active NPI Prosthodontics · Setauket, NY
NPI 1144589797 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1144589797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- 057233 (NY)
- Practice address
- 45 Route 25a
Setauket, NY 11733-2821 - Phone
- (631) 941-4435
- Fax
- (631) 941-4435
- NPI assigned
- May 16, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057233 | NY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 057233 | NY | Yes |
Addresses
Primary practice location
45 Route 25a
Setauket, NY 11733-2821
Mailing address
45 Route 25a
East Setauket, NY 11743
Phone (631) 941-4435
Other practice location 1
25710 Union Tpke
Glen Oaks, NY 11004-1252
Phone (631) 793-0745
Other providers in Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.