Healthcare Provider Details

I. General information

NPI: 1669158036
Provider Name (Legal Business Name): GABRIELLE A ABBOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

885 WESTBURY RD
WESTBURY NY
11590-5843
US

V. Phone/Fax

Practice location:
  • Phone: 877-768-8462
  • Fax:
Mailing address:
  • Phone: 516-491-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: