Provider Demographics
NPI:1477589083
Name:PATRICK ABIUSO MD PC
Entity Type:Organization
Organization Name:PATRICK ABIUSO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ABIUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-429-1910
Mailing Address - Street 1:1210 BRACE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3213
Mailing Address - Country:US
Mailing Address - Phone:856-429-1910
Mailing Address - Fax:856-429-2866
Practice Address - Street 1:1210 BRACE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3213
Practice Address - Country:US
Practice Address - Phone:856-429-1910
Practice Address - Fax:856-429-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA31840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046195Medicare ID - Type Unspecified