Provider Demographics
NPI:1851663454
Name:ALFONSO, ABIGAIL
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:ALFONSO
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 1:501 5TH AVE
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6107
Mailing Address - Country:US
Mailing Address - Phone:646-998-8128
Mailing Address - Fax:646-998-8038
Practice Address - Street 1:501 5TH AVE
Practice Address - Street 2:SUITE 1204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6107
Practice Address - Country:US
Practice Address - Phone:646-998-8128
Practice Address - Fax:646-998-8038
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY636057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse