Healthcare Provider Details

I. General information

NPI: 1376525899
Provider Name (Legal Business Name): ROBERT J ABIUSI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 MEDICAL PARK BLVD SUITE 260
WELLINGTON FL
33414-6156
US

IV. Provider business mailing address

1397 MEDICAL PARK BLVD SUITE 260
WELLINGTON FL
33414-3186
US

V. Phone/Fax

Practice location:
  • Phone: 561-739-2140
  • Fax: 561-472-0467
Mailing address:
  • Phone: 561-739-2140
  • Fax: 561-472-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9100979
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9100979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: