Provider Demographics
NPI:1679744213
Name:ABRAMOV, BORIS (ANP-BC)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:ABRAMOV
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13841 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2819
Mailing Address - Country:US
Mailing Address - Phone:917-208-5578
Mailing Address - Fax:
Practice Address - Street 1:138-41 76TH AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDEN HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:917-208-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304470363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health