Provider Demographics
NPI:1114491701
Name:ABBAS, AWN
Entity Type:Individual
Prefix:
First Name:AWN
Middle Name:
Last Name:ABBAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5772 XENIA ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3928
Mailing Address - Country:US
Mailing Address - Phone:917-238-2259
Mailing Address - Fax:
Practice Address - Street 1:5772 XENIA ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3928
Practice Address - Country:US
Practice Address - Phone:917-238-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator