NPIMap

Organization Active NPI

Functional Life

  • Early Intervention Provider Agency
  • Jamaica, NY
National Provider Identifier
1265797096
Registry record updated Jul 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
FUNCTIONAL LIFE
Practice address
8110 135TH St Apt 201
Jamaica, NY 11435-1041
Phone
(917) 412-7796
NPI assigned
Jul 9, 2012
Last updated
Jul 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2012

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

Authorized official

Name
Elena RafaelovNPI 1891169538
Title
Special Education Teacher
Phone
(917) 412-7796

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 NY Primary

Addresses

Primary practice location

8110 135TH St Apt 201
Jamaica, NY 11435-1041

Mailing address

8110 135TH St Apt 201
Jamaica, NY 11435-1041
Phone (917) 412-7796

National Provider Directory

National Provider Directory
Tax ID family
Functional Life16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

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": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1265797096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8110 135TH ST APT 201",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114351041",
            "telephone_number": "917-412-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8110 135TH ST APT 201",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114351041",
            "telephone_number": "917-412-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL LIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "RAFAELOV",
        "authorized_official_first_name": "ELENA",
        "authorized_official_title_or_position": "SPECIAL EDUCATION TEACHER",
        "authorized_official_telephone_number": "917-412-7796"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.