Provider Demographics
NPI:1730693219
Name:ABAGNALO, LIANA MARIE
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:MARIE
Last Name:ABAGNALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LOVELACE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3207
Mailing Address - Country:US
Mailing Address - Phone:646-413-2260
Mailing Address - Fax:
Practice Address - Street 1:134 LOVELACE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3207
Practice Address - Country:US
Practice Address - Phone:646-413-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist