Active NPI
Sabrina Emerald Kunciw, M.D.
- Family Medicine Physician
- Fort Drum, NY
National Provider Identifier
1245611854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101261371
- Practice address
- 11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603 - Phone
- (315) 772-2964
- NPI assigned
- Jun 10, 2015
- Last updated
- Jul 10, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101261371 | VA | Primary |
Addresses
Primary practice location
11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603
Mailing address
528 Constitution Dr
Ephrata, PA 17522-9177
Other practice location 1
121 CSH/Baach
Building #17005
Apo, AP 96205
KR
Phone (012) 746-2319
Other practice location 2
2817 Reilly St
Womack Army Medical Center
Fort Bragg, NC 28310-7324
Phone (910) 907-8922
Other practice location 3
2817 Reilly St
Womack Army Medical Center
Fort Bragg, NC 28310-7324
Phone (910) 907-8922
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101261371 | VA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1245611854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "528 CONSTITUTION DR",
"city": "EPHRATA",
"state": "PA",
"postal_code": "175229177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 MT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136022603",
"telephone_number": "315-772-2964"
}
],
"practiceLocations": [
{
"address_1": "121 CSH/BAACH",
"address_2": "Building #17005",
"address_purpose": "LOCATION",
"city": "APO",
"state": "AP",
"postal_code": "96205",
"country_code": "KR",
"telephone_number": "012-746-2319",
"country_name": "Korea, Republic of",
"address_type": "FGN"
},
{
"address_1": "2817 Reilly St",
"address_2": "Womack Army Medical Center",
"address_purpose": "LOCATION",
"city": "Fort Bragg",
"state": "NC",
"postal_code": "283107324",
"country_code": "US",
"telephone_number": "910-907-8922",
"fax_number": "910-907-6099",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2817 Reilly St",
"address_2": "Womack Army Medical Center",
"address_purpose": "LOCATION",
"city": "Fort Bragg",
"state": "NC",
"postal_code": "283107324",
"country_code": "US",
"telephone_number": "910-907-8922",
"fax_number": "910-907-6099",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KUNCIW",
"first_name": "SABRINA",
"middle_name": "EMERALD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-10",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101261371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Drum, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.