Healthcare Provider Details

I. General information

NPI: 1134732142
Provider Name (Legal Business Name): MR. WENDELL JAMIAS ABAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90-33 ELMHURST AVE.
JACKSON HEIGHTS NY
11372
US

IV. Provider business mailing address

90-33 ELMHURST AVE.
JACKSON HEIGHTS NY
11372
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-2970
  • Fax:
Mailing address:
  • Phone: 718-565-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number007790-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: