Healthcare Provider Details

I. General information

NPI: 1225067309
Provider Name (Legal Business Name): ABRAHAM ANCSELOVICS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 AVENUE P
BROOKLYN NY
11229-1109
US

IV. Provider business mailing address

1407 AVENUE P
BROOKLYN NY
11229-1109
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-4747
  • Fax: 718-998-5736
Mailing address:
  • Phone: 718-998-4747
  • Fax: 718-998-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number041619
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: