Provider Demographics
NPI:1497908966
Name:ABITBOL, LIONEL YAACOV (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:YAACOV
Last Name:ABITBOL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2419
Mailing Address - Country:US
Mailing Address - Phone:917-207-2774
Mailing Address - Fax:
Practice Address - Street 1:20 W 87TH ST
Practice Address - Street 2:APT 6C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3526
Practice Address - Country:US
Practice Address - Phone:917-207-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP64455122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice