Provider Demographics
NPI:1366716367
Name:ABELLA, MARIA VICTORIA MERCADO
Entity type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:MERCADO
Last Name:ABELLA
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 1:105 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3020
Mailing Address - Country:US
Mailing Address - Phone:845-784-4939
Mailing Address - Fax:
Practice Address - Street 1:1180 TINTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5436
Practice Address - Country:US
Practice Address - Phone:347-410-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist