Provider Demographics
NPI:1538358403
Name:TIBIAN ABRAMOVITZ PHYSICIAN PC
Entity type:Organization
Organization Name:TIBIAN ABRAMOVITZ PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIBIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-252-2500
Mailing Address - Street 1:3131 KINGS HWY STE C5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2643
Mailing Address - Country:US
Mailing Address - Phone:718-252-2500
Mailing Address - Fax:718-252-4525
Practice Address - Street 1:3131 KINGS HWY STE C5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2643
Practice Address - Country:US
Practice Address - Phone:718-252-2500
Practice Address - Fax:718-252-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWCW511Medicare PIN