1629148259 NPI number — ABILITY BEYOND DISABILITY

Table of content: (NPI 1629148259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629148259 NPI number — ABILITY BEYOND DISABILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILITY BEYOND DISABILITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629148259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 BERKSHIRE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHEL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06801-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-775-4700
Provider Business Mailing Address Fax Number:
203-775-5734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 BEDFORD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPPAQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-242-8720
Provider Business Practice Location Address Fax Number:
914-242-8762
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PASQUALINI
Authorized Official First Name:
LORI
Authorized Official Middle Name:
I
Authorized Official Title or Position:
V.P & C.A.F.O
Authorized Official Telephone Number:
203-775-4700

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  5946201R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5946201R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XN1300X , with the licence number: 5946201R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 5946201R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 5946201R ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01827967 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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