Provider Demographics
NPI:1336634922
Name:ABISROR, NATHALIE (MD)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:ABISROR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAX DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9518
Mailing Address - Country:US
Mailing Address - Phone:303-649-3350
Mailing Address - Fax:303-649-3378
Practice Address - Street 1:250 MAX DR STE 102
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9518
Practice Address - Country:US
Practice Address - Phone:303-649-3350
Practice Address - Fax:303-649-3378
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311246207Q00000X
CODR.73435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06655816Medicaid