Basic Information
Provider Information
NPI: 1811420912
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABELLA
FirstName: JASON JAMES
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2201 HEMPSTEAD TPKE
Address2:  
City: EAST MEADOW
State: NY
PostalCode: 115541859
CountryCode: US
TelephoneNumber: 5165720123
FaxNumber:  
Practice Location
Address1: 2201 HEMPSTEAD TPKE
Address2:  
City: EAST MEADOW
State: NY
PostalCode: 115541859
CountryCode: US
TelephoneNumber: 5165726501
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/05/2017
LastUpdateDate: 09/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207L00000X313616-01NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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