Active NPI
Loris Abraham
- General Practice Dentistry
- Staten Island, NY
National Provider Identifier
1972714699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 038272-1
- Practice address
- 1659 Richmond Ave
Staten Island, NY 10314-1570 - Phone
- (718) 983-6300
- Fax
- (516) 822-2396
- NPI assigned
- May 24, 2007
- Last updated
- Dec 30, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 038272-1 | NY | Primary |
Addresses
Primary practice location
1659 Richmond Ave
Staten Island, NY 10314-1570
Mailing address
53 E Hudson Ave
Englewood, NJ 07631-1816
Phone (201) 871-9022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00857763 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038272-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388361600000",
"number": "1972714699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53 E HUDSON AVE",
"city": "ENGLEWOOD",
"state": "NJ",
"postal_code": "076311816",
"telephone_number": "201-871-9022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1659 RICHMOND AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103141570",
"telephone_number": "718-983-6300",
"fax_number": "516-822-2396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABRAHAM",
"first_name": "LORIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2013-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "038272-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00857763",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.