Individual provider Active NPI

Magdalena Hennessy

  • Adult Health Nurse Practitioner
  • Quogue, NY
National Provider Identifier
1073280582
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
310386 Issued in NY
Practice address
33 Montauk Hwy
Quogue, NY 11959-4000
Phone
(631) 653-6000
NPI assigned
Aug 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 310386 NY Primary

Addresses

Primary practice location

33 Montauk Hwy
Quogue, NY 11959-4000

Mailing address

33 Lama Dr
Shirley, NY 11967-3327
Phone (631) 804-8069

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
I20250102001052 NY Order and Referring Only - Nurse Practitioner 2264969278

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peconic Family Medicine PC CurrentSince Aug 29, 2021 Accepting new patients
Paula Montagna, Ms, Rd, CDN, PLLC PastSince Aug 29, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: magdalena.hennessy@186875407826948.direct.elationemr.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1073280582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LAMA DR",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119673327",
            "telephone_number": "631-804-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MONTAUK HWY",
            "city": "QUOGUE",
            "state": "NY",
            "postal_code": "119594000",
            "telephone_number": "631-653-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNESSY",
        "first_name": "MAGDALENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-08-24",
        "certification_date": "2021-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "310386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quogue, NY

Sources for this page

Verify at the official NPI Registry.