Provider Demographics
NPI:1053351858
Name:ABRAMOVITZ, TIBIAN (MD)
Entity type:Individual
Prefix:
First Name:TIBIAN
Middle Name:
Last Name:ABRAMOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 LOWELL LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5212
Mailing Address - Country:US
Mailing Address - Phone:516-665-3513
Mailing Address - Fax:
Practice Address - Street 1:1928 LOWELL LN
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5212
Practice Address - Country:US
Practice Address - Phone:516-665-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY93542OtherBC BS
NYKP096OtherOXFORD
NY01141822Medicaid
A62469Medicare UPIN
NY35E951Medicare PIN