Individual provider Active NPI

Elyane L Michnick, APRN

  • Gerontology Nurse Practitioner
  • Shelton, CT
National Provider Identifier
1033315544
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
340647 Issued in NY
Practice address
6 Corporate Dr
Suite 420
Shelton, CT 06484-6270
Phone
(203) 925-9600
Fax
(203) 926-0594
NPI assigned
Jun 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 340647 NY Primary

Addresses

Primary practice location

6 Corporate Dr
Suite 420
Shelton, CT 06484-6270

Mailing address

494 Genesee Ave
Staten Island, NY 10312-3206
Phone (718) 948-3716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
340647NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
NP Care, LLC Past Accepting new patients
NP Care, LLC Past Accepting new patients

Organizations & group practices 2

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": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033315544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "494 GENESEE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123206",
            "telephone_number": "718-948-3716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 CORPORATE DR",
            "address_2": "SUITE 420",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846270",
            "telephone_number": "203-925-9600",
            "fax_number": "203-926-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHNICK",
        "first_name": "ELYANE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "340647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.