Provider Demographics
NPI:1902213309
Name:BRIZAN-MELBOURNE, ABIGAIL K (SPECIAL ED - INITIAL)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:K
Last Name:BRIZAN-MELBOURNE
Suffix:
Gender:F
Credentials:SPECIAL ED - INITIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12218 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1051
Mailing Address - Country:US
Mailing Address - Phone:347-423-5326
Mailing Address - Fax:
Practice Address - Street 1:12218 BENTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1051
Practice Address - Country:US
Practice Address - Phone:347-423-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY884959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist