Provider Demographics
NPI:1649472382
Name:ABERGEL, JEFFREY RAPHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RAPHAEL
Last Name:ABERGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 CROMPOND ROAD SUITE D, LL
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4146
Mailing Address - Country:US
Mailing Address - Phone:914-739-2400
Mailing Address - Fax:718-227-5814
Practice Address - Street 1:1985 CROMPOND ROAD SUITE D, LL
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-739-2400
Practice Address - Fax:718-227-5814
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242608207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY242608OtherNEW YORK STATE LICENSE
NY02984045Medicaid
NJ25MA08579300OtherNJ STATE LICENSE
NJ25MA08579300OtherNJ STATE LICENSE