Healthcare Provider Details

I. General information

NPI: 1316102445
Provider Name (Legal Business Name): ALEXANDR ABRAMOV MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8746 20TH AVE FL 3
BROOKLYN NY
11214-4802
US

IV. Provider business mailing address

8746 20TH AVE FL 3
BROOKLYN NY
11214-4802
US

V. Phone/Fax

Practice location:
  • Phone: 718-234-9191
  • Fax: 718-234-8591
Mailing address:
  • Phone: 718-234-9191
  • Fax: 718-234-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203972
License Number StateNY

VIII. Authorized Official

Name: MS. OLEKSANDRA KOVAL
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 718-234-9191