Healthcare Provider Details

I. General information

NPI: 1417870981
Provider Name (Legal Business Name): MR. KEVIN ABANO DE LA CRUZ I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BARTLETT ST
BROOKLYN NY
11206-4463
US

IV. Provider business mailing address

89 BARTLETT ST
BROOKLYN NY
11206-4463
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax: 718-782-1538
Mailing address:
  • Phone: 718-828-2666
  • Fax: 718-782-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN38411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: