Basic Information
| Provider Information | |||||||||
| NPI: | 1770651572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | VEENA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 HORIZON DR | ||||||||
| Address2: | PEDERSON KRAG CTR | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319208000 | ||||||||
| FaxNumber: | 6319208165 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 PARK AVE | ||||||||
| Address2: | STEPPING STONE CDT FAMILY SERVICE LEAGUE | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314274001 | ||||||||
| FaxNumber: | 6314271778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 178152 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00665283 | 05 | NY | MEDICAID |