Healthcare Provider Details

I. General information

NPI: 1700893500
Provider Name (Legal Business Name): ROBERT J. ABIDIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 NEW HYDE PARK RD
GARDEN CITY NY
11530-5117
US

IV. Provider business mailing address

33 NEW HYDE PARK RD
GARDEN CITY NY
11530-5117
US

V. Phone/Fax

Practice location:
  • Phone: 516-354-8716
  • Fax: 516-354-0197
Mailing address:
  • Phone: 516-354-8716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: