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General NPI Number Information
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NPI Number | 1174390355
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Entity Type | Individual
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Provider Name | ERIC ABAYEV
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Gender | Male
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 6743 CENTRAL AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6653
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Country | US
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Telephone | 347-445-3797
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Fax |
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Provider Business Mailing Address
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Address Line | 6929 167TH ST
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 071176
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License Number State | NY
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