Provider Demographics
NPI:1962834077
Name:BRIAN ABALUCK, LLC
Entity Type:Organization
Organization Name:BRIAN ABALUCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABALUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-565-1358
Mailing Address - Street 1:2 INDUSTRIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1645
Mailing Address - Country:US
Mailing Address - Phone:484-565-1358
Mailing Address - Fax:484-565-1312
Practice Address - Street 1:2 INDUSTRIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1645
Practice Address - Country:US
Practice Address - Phone:484-565-1358
Practice Address - Fax:484-565-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD44552332084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty