Provider Demographics
NPI:1619947686
Name:ABARBANEL, JACK A (DO)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:A
Last Name:ABARBANEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N431
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5806
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:1604 BURTNER RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2845
Practice Address - Country:US
Practice Address - Phone:724-230-3030
Practice Address - Fax:724-230-3001
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003294L2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011033160004Medicaid
PA10921831OtherCAQH
PA192265OtherHIGHMARK BS
PA192265SEHMedicare PIN
PAB40986Medicare UPIN
PA192265UUWMedicare PIN
PAP00397169Medicare PIN
PA192265QEHMedicare PIN