Healthcare Provider Details

I. General information

NPI: 1750554572
Provider Name (Legal Business Name): ABBY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2008
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR SUITE 106
NEWARK DE
19713-2137
US

IV. Provider business mailing address

1 CENTURIAN DR
NEWARK DE
19713-2137
US

V. Phone/Fax

Practice location:
  • Phone: 302-999-0003
  • Fax: 302-322-9241
Mailing address:
  • Phone: 302-999-0003
  • Fax: 302-999-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARLEN D STONE
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 302-999-0003