Basic Information
| Provider Information | |||||||||
| NPI: | 1588203756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GADELOV | ||||||||
| FirstName: | ABRAHAM | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 GLEN COVE AVE | ||||||||
| Address2: | |||||||||
| City: | SEA CLIFF | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115791455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166761742 | ||||||||
| FaxNumber: | 5166769662 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 GLEN COVE AVE | ||||||||
| Address2: | |||||||||
| City: | SEACLIFF | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115792543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166761742 | ||||||||
| FaxNumber: | 5166769662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2020 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 024858 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.