Healthcare Provider Details

I. General information

NPI: 1528994969
Provider Name (Legal Business Name): ETHAN EDWARD ABELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE BLDG 3
ROCHESTER NY
14621-3095
US

IV. Provider business mailing address

137 HARVARD ST APT 2
ROCHESTER NY
14607-3167
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4000
  • Fax: 585-922-2951
Mailing address:
  • Phone: 585-775-5692
  • 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: