Healthcare Provider Details

I. General information

NPI: 1962654434
Provider Name (Legal Business Name): EDWARD NISONOVICH ABAYEV PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 03/04/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7494
US

IV. Provider business mailing address

1901 1ST AVE
NEW YORK NY
10029-7494
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6262
  • Fax:
Mailing address:
  • Phone: 212-423-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: