Healthcare Provider Details

I. General information

NPI: 1639606536
Provider Name (Legal Business Name): ABIGAIL ELIZABETH CLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 336-671-9027
  • Fax: 947-209-6209
Mailing address:
  • Phone: 718-579-6151
  • Fax: 947-209-6209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number316694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: