Organization
FACIAL PLASTIC, RECONSTRUCTIVE & LASER SURGERY, PLLC
Active
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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