Provider Demographics
NPI:1760601348
Name:ABREU, RAFAEL MAXIMILIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:MAXIMILIAN
Last Name:ABREU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 AUSTIN ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6930
Mailing Address - Country:US
Mailing Address - Phone:917-687-1085
Mailing Address - Fax:718-520-2561
Practice Address - Street 1:7734 AUSTIN ST APT 5D
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6930
Practice Address - Country:US
Practice Address - Phone:917-687-1085
Practice Address - Fax:718-520-2561
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5356213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU06666Medicare UPIN