Active NPI
Christie M Czarnecki, APRN
- Critical Care Neonatal Nurse Practitioner
- Derby, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Neonatal Nurse Practitioner
- License
- 9360
- Practice address
- 130 Division St
Derby, CT 06418-1326 - Phone
- (203) 732-7252
- Fax
- (203) 732-1539
- NPI assigned
- Jul 4, 2019
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 9360 | CT | |
| Critical Care Neonatal Nurse Practitioner | 363LN0005X | F350455 | NY | |
| Critical Care Neonatal Nurse Practitioner | 363LN0005X | 9360 | CT | Primary |
Addresses
Primary practice location
130 Division St
Derby, CT 06418-1326
Mailing address
67 Maple Ave
Derby, CT 06418-1328
Phone (203) 732-7252
Other practice location 1
525 E 68th St
New York, NY 10065-4870
Phone (212) 746-0318
Other practice location 2
71 Haynes St
Manchester, CT 06040-4131
Phone (860) 647-4735
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F350455 | Medicaid | NY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | chc9212@nyp.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9360 | CT | MD | Critical Care Neonatal Nurse Practitioner |
| F350455 | NY | MD | Critical Care Neonatal Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prospect CT Medical Foundation, Inc. | Nurse Practitioner | Current | Accepting new patients |
| Griffin Faculty Physicians, Inc. | Current | Accepting new patients |
Locations
1801 W Olympic Blvd
#2201
Pasadena, CA 91199
130 Division St
Derby, CT 06418
Phone (203) 732-1330
67 Maple Ave
Derby, CT 06418
Phone (203) 732-0699
71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981
18 Haynes St
Uppr
Manchester, CT 06040
Phone (860) 649-7557
64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142
Interoperability endpoints
- cczarnecki543112@direct.ynhh.org
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.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Derby, CT
- NPI 1598755605
-
- Family Medicine Physician
- Manchester, CT
- NPI 1144677568
Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1255993762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 MAPLE AVE",
"city": "DERBY",
"state": "CT",
"postal_code": "064181328",
"telephone_number": "203-732-7252",
"fax_number": "203-732-1539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 DIVISION ST",
"city": "DERBY",
"state": "CT",
"postal_code": "064181326",
"telephone_number": "203-732-7252",
"fax_number": "203-732-1539"
}
],
"practiceLocations": [
{
"address_1": "525 E 68th St",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100654870",
"country_code": "US",
"telephone_number": "212-746-0318",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "71 Haynes St",
"address_purpose": "LOCATION",
"city": "Manchester",
"state": "CT",
"postal_code": "060404131",
"country_code": "US",
"telephone_number": "860-647-4735",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CZARNECKI",
"first_name": "CHRISTIE",
"middle_name": "M",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-04",
"last_updated": "2024-04-30",
"certification_date": "2024-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CT",
"license": "9360",
"primary": false
},
{
"code": "363LN0005X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Neonatal, Critical Care",
"state": "NY",
"license": "F350455",
"primary": false
},
{
"code": "363LN0005X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Neonatal, Critical Care",
"state": "CT",
"license": "9360",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "F350455",
"state": "NY"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "chc9212@nyp.org",
"affiliation": "N",
"endpointDescription": "e-mail",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "525 E 68th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100654870",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Derby, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.