Healthcare Provider Details

I. General information

NPI: 1477715035
Provider Name (Legal Business Name): ABRA GRIZE MABASA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NEW MILFORD TPKE
NEW PRESTON CT
06777-1703
US

IV. Provider business mailing address

125 NEW MILFORD TPKE
NEW PRESTON CT
06777-1703
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-7318
  • Fax: 860-868-7310
Mailing address:
  • Phone: 860-868-7318
  • Fax: 860-868-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046475
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: