Basic Information
| Provider Information | |||||||||
| NPI: | 1215961958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAMOVICI | ||||||||
| FirstName: | MIREL | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076314398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015675787 | ||||||||
| FaxNumber: | 2015677652 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076316581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015675787 | ||||||||
| FaxNumber: | 2015677652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MA057981 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | MA6097201 | 05 | NJ | MEDICAID |