Basic Information
| Provider Information | |||||||||
| NPI: | 1962654434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABAYEV | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | NISONOVICH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14419 77TH AVE | ||||||||
| Address2: | |||||||||
| City: | KEW GARDENS HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113673129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183505722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1901 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236262 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 51760 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.