Provider Demographics
NPI:1558166355
Name:ABDURACHMANOV, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ABDURACHMANOV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 WESTON DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3271
Mailing Address - Country:US
Mailing Address - Phone:718-551-6778
Mailing Address - Fax:
Practice Address - Street 1:126 MELVILLE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4235
Practice Address - Country:US
Practice Address - Phone:732-886-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12579260103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst