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Organization

FACIAL PLASTIC, RECONSTRUCTIVE & LASER SURGERY, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MANOJ TIMOTHY ABRAHAM M.D., F.A.C.S. (OWNER)
(845) 454-8025
Entity
Organization

Contact information

Practice address
82 N WATER ST, POUGHKEEPSIE, NY 12601-1721
(845) 454-8025
(845) 454-8026
Mailing address
82 N WATER ST, POUGHKEEPSIE, NY 12601-1721
(845) 454-8025
(845) 454-8026

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
211519
NY
207YS0123X
Facial Plastic Surgery Physician
Primary
211519
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000415207001
HEALTHNOW
NY
01
10074336
CDPHP
NY
01
3289877
AETNA HMO
NY
01
362957
MVP ENT
NY
01
363203
MVP PLASTIC
NY
01
7539468
AETNA PPO POS
NY
01
7M7521
BLUE CROSS BLUE SHIELD
NY
01
P3063915
OXFORD LIBERTY, FREEDOM
NY
Enumeration date
03/04/2007
Last updated
10/01/2008
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