Individual provider Active NPI

Vincent Abanilla, PA-C

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1366201808
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1 University PLZ
Brooklyn, NY 11201-5301
Phone
(973) 780-7906
NPI assigned
Mar 18, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 031597 NY
Surgical Physician Assistant 363AS0400X 031597 NY
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1 University PLZ
Brooklyn, NY 11201-5301

Mailing address

138 Plenge Dr
Belleville, NJ 07109-1547

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260108004065 NY Practitioner - Physician Assistant 4183100167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

121 Dekalb Ave
Brooklyn, NY 11201-5493

PO Box
Suite 2000
East Syracuse, NY 13057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
031597NYMDMedical Physician Assistant

Practice roles (1 of 5)

OrganizationSpecialtyStatusNew patients
TBHC Physician Services PC CurrentSince Dec 1, 2025 Accepting new patients

Locations

86 Saint Felix St
Brooklyn, NY 11217
Phone (718) 250-6813

121 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 250-6604

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1366201808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 PLENGE DR",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY PLZ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015301",
            "telephone_number": "973-780-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABANILLA",
        "first_name": "VINCENT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "031597",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "031597",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.