Individual provider Active NPI

Abraham Thomas, M.D.

  • Pediatrics Physician
  • Paterson, NJ
National Provider Identifier
1275619611
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MA62740 Issued in NJ
Practice address
675 Broadway
Paterson, NJ 07514-1444
Phone
(973) 523-1213
NPI assigned
Oct 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MA62740 NJ Primary

Addresses

Primary practice location

675 Broadway
Paterson, NJ 07514-1444

Mailing address

12 Ridgeway Ave
West Orange, NJ 07052-3208
Phone (973) 669-6761

Other identifiers 1

IdentifierTypeStateIssuer
2821001MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190225000134 NJ Practitioner - Pediatric Medicine 3072852763 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA62740NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC Pediatrics CurrentSince Apr 1, 2019 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Apr 1, 2019 Accepting new patients
A.G. Dikengil, MD, PA Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

38 Meadowlands Pkwy
Ste 205
Secaucus, NJ 07094
Phone (201) 552-2357

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Interoperability endpoints

  • Direct secure messaging: athomas77062@direct.optum.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275619611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 RIDGEWAY AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070523208",
            "telephone_number": "973-669-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 BROADWAY",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141444",
            "telephone_number": "973-523-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "ABRAHAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA62740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2821001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paterson, NJ

Sources for this page

Verify at the official NPI Registry.