Active NPI
Vincent Abanilla, PA-C
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1366201808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 031597 | NY | MD | Medical Physician Assistant |
Practice roles (1 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TBHC Physician Services PC | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.