Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 349091 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 349091 | NY |
NPI | 1598416927 |
---|---|
Provider Name | Gregory Abramov |
First Address | Brooklyn, NY 11234-6718 |
Second Address | Brooklyn, NY 11220-2913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2022 |
Last Update Date | 18/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
349091 | STATE LICENSE (01) | NY |