Provider Demographics
NPI:1386967040
Name:ABILEVITZ, JACOB (RPH)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:ABILEVITZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2239
Mailing Address - Country:US
Mailing Address - Phone:718-376-3313
Mailing Address - Fax:718-376-3060
Practice Address - Street 1:807 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-376-3313
Practice Address - Fax:718-376-3060
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist