NPIMap

Individual provider Active NPI

Ianina Suponitsky, AGNP

  • Adult Health Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1124407465
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F307084-1 Issued in NY
Practice address
1773 E 12TH St
#4D
Brooklyn, NY 11229-1051
Phone
(347) 713-3023
Fax
(718) 208-4022
NPI assigned
May 19, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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 F307084-1 NY Primary

Addresses

Primary practice location

1773 E 12TH St
#4D
Brooklyn, NY 11229-1051

Mailing address

PO Box 290421
Brooklyn, NY 11229-0421
Phone (347) 713-3023

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170824003674 NY Practitioner - Nurse Practitioner 0840590121 Reassigns benefits to 3 organizations
Practice locations: Brooklyn, NY

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Interborough Developmental and Consultation Center IncGroup PAC ID 7911898192, 167 clinicians
Avant-Garde Psychiatric Consulting PLLCGroup PAC ID 1456613488, 6 clinicians

Practice addresses (Care Compare)

1623 Kings Hwy
Brooklyn, NY 11229-1209
Phone 9292737601426

50 Brighton 11TH St
Brooklyn, NY 11235-5304
Phone (929) 617-8635

535 E 70TH St
New York, NY 10021-4823
Phone (212) 774-7598

56 Brighton 11TH St
Suite 2a
Brooklyn, NY 11235-5304
Phone (929) 617-8635

Hospital & facility affiliations

  • Hospital for Special Surgery Hospital, New York, NY, CCN 330270

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F307084-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avant-Garde Psychiatric Consulting PLLC CurrentSince Apr 1, 2025 Accepting new patients
New York Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Jun 25, 2017 Accepting new patients
Interborough Developmental and Consultation Center, Inc. CurrentSince Mar 13, 2019 Accepting new patients
Interborough Developmental and Consultation Center, Inc. CurrentSince Mar 13, 2019 Accepting new patients
New York Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Jun 25, 2017 Accepting new patients

Locations

1623 Kings Hwy
Brooklyn, NY 11229
Phone (718) 307-6800

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1124407465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290421",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112290421",
            "telephone_number": "347-713-3023",
            "fax_number": "718-208-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1773 E 12TH ST",
            "address_2": "#4D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291051",
            "telephone_number": "347-713-3023",
            "fax_number": "718-208-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPONITSKY",
        "first_name": "IANINA",
        "credential": "AGNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-19",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F307084-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.