Provider Demographics
NPI:1396845798
Name:ABADIR, DALE M (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:M
Last Name:ABADIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 S RIDGE ST
Mailing Address - Street 2:SUITE LL3
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2867
Mailing Address - Country:US
Mailing Address - Phone:914-937-5500
Mailing Address - Fax:914-937-7678
Practice Address - Street 1:90 S RIDGE ST
Practice Address - Street 2:SUITE LL3
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2867
Practice Address - Country:US
Practice Address - Phone:914-937-5500
Practice Address - Fax:914-937-7678
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114927207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B16725Medicare UPIN
NY572121Medicare ID - Type Unspecified