Healthcare Provider Details

I. General information

NPI: 1538768437
Provider Name (Legal Business Name): ISHACK ABDUL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 SOUTHERN BOULEVARD
BRONX NY
10459-4506
US

IV. Provider business mailing address

55 WATER ST FL 2
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 646-680-5250
  • Fax: 646-751-6937
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: