Provider Demographics
NPI:1780770131
Name:ABSELET, DENISE A (DO)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:ABSELET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225-15 ROUTE 347
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-331-1000
Mailing Address - Fax:631-928-7436
Practice Address - Street 1:5225-15 ROUTE 347
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-331-1000
Practice Address - Fax:631-928-7436
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1969171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55637OtherVYTRA
NY110114122OtherRAILROAD MEDICARE
NY5033816004OtherCIGNA
NYCP693OtherOXFORD
NY2323637OtherAETNA
NY01582521Medicaid
NYCP693OtherOXFORD
NY5033816004OtherCIGNA
NY7421611051Medicare PIN