Provider Demographics
NPI:1215301015
Name:ABERGEL, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:ABERGEL
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 1:54 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2821
Mailing Address - Country:US
Mailing Address - Phone:917-692-0064
Mailing Address - Fax:
Practice Address - Street 1:54 BIRCH DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2821
Practice Address - Country:US
Practice Address - Phone:917-692-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY459065931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist