Healthcare Provider Details

I. General information

NPI: 1598416927
Provider Name (Legal Business Name): GREGORY ABRAMOV NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5223 9TH AVE
BROOKLYN NY
11220-2913
US

IV. Provider business mailing address

2442 E 65TH ST
BROOKLYN NY
11234-6718
US

V. Phone/Fax

Practice location:
  • Phone: 718-431-2959
  • Fax: 718-431-2974
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number349091
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: