Provider Demographics
NPI:1649577495
Name:ABRINA, VANESSA MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:MAE
Last Name:ABRINA
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 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1725
Mailing Address - Country:US
Mailing Address - Phone:732-787-0568
Mailing Address - Fax:732-787-0270
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1725
Practice Address - Country:US
Practice Address - Phone:732-787-0568
Practice Address - Fax:732-787-0270
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46041207R00000X
390200000X
NJ25MA09476100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0446769Medicaid