Provider Demographics
NPI:1063626547
Name:ABILIS
Entity type:Organization
Organization Name:ABILIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-531-1880
Mailing Address - Street 1:50 GLENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-4140
Mailing Address - Country:US
Mailing Address - Phone:203-324-1880
Mailing Address - Fax:203-324-4390
Practice Address - Street 1:1150 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5530
Practice Address - Country:US
Practice Address - Phone:203-324-1880
Practice Address - Fax:203-324-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186012Medicaid