1609042985 NPI number — MARY GRACE ABONETS LUSAN-URENA PT

Table of content: MARY GRACE ABONETS LUSAN-URENA PT (NPI 1609042985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609042985 NPI number — MARY GRACE ABONETS LUSAN-URENA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUSAN-URENA
Provider First Name:
MARY GRACE
Provider Middle Name:
ABONETS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUSAN
Provider Other First Name:
MARY GRACE
Provider Other Middle Name:
ABONETS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609042985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEWLETT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11557-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-374-6838
Provider Business Mailing Address Fax Number:
516-374-2362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
ISLAND MUSCULOSKELETAL CARE, MD,PC
Provider Business Practice Location Address City Name:
VALLEY STREAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11580-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-887-1787
Provider Business Practice Location Address Fax Number:
516-887-2059
Provider Enumeration Date:
05/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  023781 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com