Healthcare Provider Details

I. General information

NPI: 1619506573
Provider Name (Legal Business Name): MICHEL M ABBOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 61ST ST STE 7C
NEW YORK NY
10065-8185
US

IV. Provider business mailing address

115 E 61ST ST STE 7C
NEW YORK NY
10065-8185
US

V. Phone/Fax

Practice location:
  • Phone: 212-444-8006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number336513
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number336513
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: