Healthcare Provider Details

I. General information

NPI: 1043141583
Provider Name (Legal Business Name): ADAM ABDALLAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 SHAKESPEARE AVE APT 4E
BRONX NY
10452-3001
US

IV. Provider business mailing address

1246 SHAKESPEARE AVE
BRONX NY
10452-3021
US

V. Phone/Fax

Practice location:
  • Phone: 929-752-1974
  • Fax:
Mailing address:
  • Phone: 929-752-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN02304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: