Healthcare Provider Details

I. General information

NPI: 1275219800
Provider Name (Legal Business Name): SUSAN HANNAH ABRAMOVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

17 SHERMAN RD
OLD BETHPAGE NY
11804-1427
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1116
  • Fax:
Mailing address:
  • Phone: 516-497-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: