Provider Demographics
NPI:1679228886
Name:SURIEL ABREU, IVELY MARSIELY
Entity Type:Individual
Prefix:
First Name:IVELY
Middle Name:MARSIELY
Last Name:SURIEL ABREU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10835 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2930
Mailing Address - Country:US
Mailing Address - Phone:347-665-8665
Mailing Address - Fax:
Practice Address - Street 1:10835 47TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2930
Practice Address - Country:US
Practice Address - Phone:347-665-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator