Provider Demographics
NPI:1043424989
Name:ABERGEL INSTITUTE
Entity Type:Organization
Organization Name:ABERGEL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ABERGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-2005
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 1250 W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-829-2005
Mailing Address - Fax:310-453-9201
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 1250 W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-829-2005
Practice Address - Fax:310-453-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41084207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83586Medicare UPIN