Basic Information
Provider Information
NPI: 1760832869
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABRAMOWSKI
FirstName: AARON
MiddleName: STEVEN
NamePrefix:  
NameSuffix:  
Credential: AA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 821 BLUE SAGE AVE SW
Address2:  
City: LOS LUNAS
State: NM
PostalCode: 870316625
CountryCode: US
TelephoneNumber: 4405549592
FaxNumber:  
Practice Location
Address1: 2211 LOMAS BLVD NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871062719
CountryCode: US
TelephoneNumber: 5052722610
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2016
LastUpdateDate: 09/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000XAA2016-002NMY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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