Provider Demographics
NPI:1609874742
Name:ABRAHAM, AKIVA D (MD)
Entity type:Individual
Prefix:
First Name:AKIVA
Middle Name:D
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1500
Mailing Address - Country:US
Mailing Address - Phone:518-688-2081
Mailing Address - Fax:
Practice Address - Street 1:950 ROUTE 146
Practice Address - Street 2:SUITE 100
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3667
Practice Address - Country:US
Practice Address - Phone:518-373-1165
Practice Address - Fax:518-348-1849
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206885-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01768758Medicaid
NY01768758Medicaid
RA1615Medicare ID - Type Unspecified