Provider Demographics
NPI:1366494361
Name:POTENCION, ABRAHAM DASALLA (APRN, BC)
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:DASALLA
Last Name:POTENCION
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Gender:M
Credentials:APRN, BC
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Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-6134
Mailing Address - Fax:718-226-6133
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-6134
Practice Address - Fax:718-226-6133
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY332578363LF0000X
NJ26NJ00115800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily