Healthcare Provider Details

I. General information

NPI: 1760601348
Provider Name (Legal Business Name): RAFAEL MAXIMILIAN ABREU D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7734 AUSTIN ST APT 5D
FOREST HILLS NY
11375-6930
US

IV. Provider business mailing address

7734 AUSTIN ST APT 5D
FOREST HILLS NY
11375-6930
US

V. Phone/Fax

Practice location:
  • Phone: 917-687-1085
  • Fax: 718-520-2561
Mailing address:
  • Phone: 917-687-1085
  • Fax: 718-520-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: