Provider Demographics
NPI:1891274627
Name:POWERS, ABIGAIL RUTH
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:RUTH
Last Name:POWERS
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 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-9564
Mailing Address - Fax:212-305-6307
Practice Address - Street 1:177 FT WASHINGTON AVE
Practice Address - Street 2:MHB 5 GARDEN NORTH ROOM 5-435
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-9564
Practice Address - Fax:212-305-6307
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431350363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care