Basic Information
| Provider Information | |||||||||
| NPI: | 1780112789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABDUL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | TEMILOLA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | RN-BC, MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WATER ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100410004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186802888 | ||||||||
| FaxNumber: | 5165425556 | ||||||||
| Practice Location | |||||||||
| Address1: | 16959 137TH AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHDALE VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466804227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2017 | ||||||||
| LastUpdateDate: | 09/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F341113-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.