NPIMap

Organization Active NPI

Abundant Life Agency

  • Early Intervention Provider Agency
  • Brooklyn, NY
National Provider Identifier
1073869459
Registry record updated Aug 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
21900 Issued in NY
Legal business name
ABUNDANT LIFE AGENCY
Practice address
827 Clarkson Ave
Brooklyn, NY 11203-2256
Phone
(718) 735-7151
Fax
(718) 735-7141
NPI assigned
Aug 3, 2012
Last updated
Aug 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Johann Andrea RichardsonNPI 1770839011
Title
Service Coordinator
Phone
(718) 735-7151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 21900 NY Primary

Addresses

Primary practice location

827 Clarkson Ave
Brooklyn, NY 11203-2256

Mailing address

827 Clarkson Ave
Brooklyn, NY 11203-2256
Phone (718) 735-7151

Other identifiers 1

IdentifierTypeStateIssuer
1992903736MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Abundant Life Agency4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343952000000",
    "number": "1073869459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032256",
            "telephone_number": "718-735-7151",
            "fax_number": "718-735-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032256",
            "telephone_number": "718-735-7151",
            "fax_number": "718-735-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIFE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-03",
        "last_updated": "2012-08-03",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "JOHANN",
        "authorized_official_middle_name": "ANDREA",
        "authorized_official_title_or_position": "SERVICE COORDINATOR",
        "authorized_official_telephone_number": "718-735-7151",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "21900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992903736",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.