Individual provider Active NPI

Emma M Connelly, MD

  • Student in an Organized Health Care Education/Training Program
  • Elmira, NY
National Provider Identifier
1255071585
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
1255071585 Issued in NY
Practice address
600 Roe Ave
Elmira, NY 14905-1629
Phone
(607) 737-4100
NPI assigned
Apr 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 1255071585 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X 1255071585 ME
Student in an Organized Health Care Education/Training Program 390200000X NM

Addresses

Primary practice location

600 Roe Ave
Elmira, NY 14905-1629

Mailing address

600 Roe Ave
Elmira, NY 14905-1629
Phone (607) 737-4100

Other practice location 1

895 Union St Ste 12
Bangor, ME 04401-3054
Phone (207) 973-7979

Other practice location 2

Msc09 5040 1 University Of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-8291

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220623003322 NM Order and Referring Only - Family PracticePractitioner - Family Practice 6002295821

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1255071585MEMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Maine Medical Center CurrentSince Jul 14, 2024 Accepting new patients
Eastern Maine Medical Center PastSince Jul 14, 2024 Accepting new patients

Locations

895 Union St
Ste 12
Bangor, ME 04401
Phone (207) 973-7973

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": "1648771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1255071585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 ROE AVE",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149051629",
            "telephone_number": "607-737-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ROE AVE",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149051629",
            "telephone_number": "607-737-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "895 Union St Ste 12",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044013054",
            "country_code": "US",
            "telephone_number": "207-973-7979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Msc09 5040 1 University Of New Mexico",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871310001",
            "country_code": "US",
            "telephone_number": "505-272-8291",
            "fax_number": "505-272-1348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "EMMA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-01",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "1255071585",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ME",
            "license": "1255071585",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmira, NY

Sources for this page

Verify at the official NPI Registry.