Individual
TRACY IVAN ABRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1650 GRAND CONCOURSE, BRONX, NY 10457
(718) 901-8484
Mailing address
187 N. BROOKSIDE AVE., FREEPORT, NY 11520-1928
(516) 546-2980
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
006753-1
NY
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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