Provider Demographics
NPI:1073645727
Name:ABT, RENEE JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:JUDITH
Last Name:ABT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:JUDITH
Other - Last Name:NOSSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:185 W END AVE
Mailing Address - Street 2:STE 24C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5539
Mailing Address - Country:US
Mailing Address - Phone:212-874-2724
Mailing Address - Fax:212-874-4010
Practice Address - Street 1:185 W END AVE
Practice Address - Street 2:STE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5539
Practice Address - Country:US
Practice Address - Phone:212-874-2724
Practice Address - Fax:212-874-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100643-12084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00967717Medicaid
NY00967717Medicaid
NYB19756Medicare UPIN