Healthcare Provider Details

I. General information

NPI: 1821844580
Provider Name (Legal Business Name): JEAN CARLOS ABREU PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 E 19TH ST
HUNTINGTON STATION NY
11746-2901
US

IV. Provider business mailing address

83 E 19TH ST
HUNTINGTON STATION NY
11746-2901
US

V. Phone/Fax

Practice location:
  • Phone: 929-245-6699
  • Fax:
Mailing address:
  • Phone: 929-245-6699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002073-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: