Basic Information
| Provider Information | |||||||||
| NPI: | 1649472382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABERGEL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | RAPHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4106 HYLAN BLVD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103083335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182267855 | ||||||||
| FaxNumber: | 7182275814 | ||||||||
| Practice Location | |||||||||
| Address1: | 4106 HYLAN BLVD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103083335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1822678557 | ||||||||
| FaxNumber: | 7182275814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 242608 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 02984045 | 05 | NY | MEDICAID | 25MA08579300 | 01 | NJ | NJ STATE LICENSE | OTHER | 242608 | 01 | NY | NEW YORK STATE LICENSE | OTHER |