Provider Demographics
NPI:1881615730
Name:ABOULIAN, JILL R (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:R
Last Name:ABOULIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1254
Mailing Address - Country:US
Mailing Address - Phone:203-271-2120
Mailing Address - Fax:203-272-3197
Practice Address - Street 1:1781 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1254
Practice Address - Country:US
Practice Address - Phone:203-271-2120
Practice Address - Fax:203-272-3197
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00293363A00000X
CT2340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004051Medicaid
RI9004051Medicaid
RIP74562Medicare UPIN
SC1153Medicare PIN
SCAA2097Medicare UPIN