Individual provider Active NPI

Jessica Nedelka, FNP

  • Family Nurse Practitioner
  • Rego Park, NY
National Provider Identifier
1073235008
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F348541 Issued in NY
Practice address
9525 Queens Blvd
Rego Park, NY 11374-4510
Phone
(516) 734-8500
NPI assigned
Sep 15, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 718616 NY
Family Nurse Practitioner 363LF0000X F348541 NY Primary

Addresses

Primary practice location

9525 Queens Blvd
Rego Park, NY 11374-4510

Mailing address

9525 Queens Blvd
Rego Park, NY 11374-4510
Phone (516) 734-8500

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
I20230403000353 NY Practitioner - Nurse Practitioner 0648645820 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
718616NYMDRegistered Nurse
F348541NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Dec 28, 2022 Accepting new patients
North Shore - Lij Medical PC CurrentSince Dec 28, 2022 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

9525 Queens Blvd
Rego Park, NY 11374
Phone (718) 286-1000

972 Brush Hollow Rd
Westbury, NY 11590

Interoperability endpoints

  • Direct secure messaging: jessicanedelka@nslijmedgr.allscriptsdirect.net
  • Direct secure messaging: jnedelka303328@nyumc.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1073235008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9525 QUEENS BLVD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744510",
            "telephone_number": "516-734-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 QUEENS BLVD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744510",
            "telephone_number": "516-734-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEDELKA",
        "first_name": "JESSICA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "718616",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F348541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.