Basic Information
| Provider Information | |||||||||
| NPI: | 1700286424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABALOS | ||||||||
| FirstName: | KEVIN ALFRED | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WATER STREET 2ND FLOOR CRED DEPT | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100410004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466802888 | ||||||||
| FaxNumber: | 5165425556 | ||||||||
| Practice Location | |||||||||
| Address1: | 206-20 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | CAMBRIA HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114111524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184796600 | ||||||||
| FaxNumber: | 7182647080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 017937 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.