Active NPI
Nellie Konnikov, MD
- Procedural Dermatology Physician
- Boston, MA
National Provider Identifier
1376646638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- License
- 50447
- Practice address
- 150 S Hungtington Ave
Boston, MA 02130 - Phone
- (857) 364-4757
- Fax
- (857) 364-6604
- NPI assigned
- Sep 5, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MA | ||
| Procedural Dermatology Physician | 207NS0135X | 50447 | MA | Primary |
Addresses
Primary practice location
150 S Hungtington Ave
Boston, MA 02130
Mailing address
150 S Hungtington St
Boston, MA 02130
Phone (857) 364-4757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50447 | MA | MD | Procedural Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1376646638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 S HUNGTINGTON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "02130",
"telephone_number": "857-364-4757",
"fax_number": "857-364-6604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S HUNGTINGTON AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "02130",
"telephone_number": "857-364-4757",
"fax_number": "857-364-6604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONNIKOV",
"first_name": "NELLIE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-05",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MA",
"license": null,
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "MA",
"license": "50447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.