Healthcare Provider Details

I. General information

NPI: 1578037701
Provider Name (Legal Business Name): ABRAHAM OXILAS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

11548 229TH ST
CAMBRIA HEIGHTS NY
11411-1408
US

V. Phone/Fax

Practice location:
  • Phone: 917-698-5434
  • Fax:
Mailing address:
  • Phone: 917-698-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: