Provider Demographics
NPI:1669563722
Name:ABIS, LEOPOLDO LEONARDO JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:LEONARDO
Last Name:ABIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1528
Mailing Address - Country:US
Mailing Address - Phone:845-876-2051
Mailing Address - Fax:845-876-2052
Practice Address - Street 1:18 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1528
Practice Address - Country:US
Practice Address - Phone:845-876-2051
Practice Address - Fax:845-876-2052
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
319654OtherMOHAWK VALLEN PLAN
NY141814244OtherTAX ID #
NY141814244OtherTAX ID #
F97055Medicare UPIN