Provider Demographics
NPI:1841358165
Name:DAVID M ABDOO
Entity type:Organization
Organization Name:DAVID M ABDOO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-797-8396
Mailing Address - Street 1:414 TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1641
Mailing Address - Country:US
Mailing Address - Phone:315-797-4374
Mailing Address - Fax:315-797-6549
Practice Address - Street 1:414 TRENTON AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1641
Practice Address - Country:US
Practice Address - Phone:315-797-4374
Practice Address - Fax:315-797-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0183211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS86583Medicare UPIN
NYDD4067Medicare PIN