Provider Demographics
NPI:1306218342
Name:VANESSA MAE S. ABRINA
Entity Type:Organization
Organization Name:VANESSA MAE S. ABRINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:ABRINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-209-0485
Mailing Address - Street 1:319 MAIN ST STE B4
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-2062
Mailing Address - Country:US
Mailing Address - Phone:908-209-0485
Mailing Address - Fax:
Practice Address - Street 1:319 MAIN ST STE B4
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-2062
Practice Address - Country:US
Practice Address - Phone:908-209-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09476100207R00000X
KY46041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty