Healthcare Provider Details

I. General information

NPI: 1902284482
Provider Name (Legal Business Name): BRIAN J. ABITTAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST FL 5
NEW YORK NY
10028-3001
US

IV. Provider business mailing address

450 CLARKSON AVE
BROOKLYN NY
11203-2098
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number285104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: