Individual provider Active NPI

Gina M Molinelli

  • Licensed Practical Nurse
  • Ronkonkoma, NY
National Provider Identifier
1396480752
Registry record updated Apr 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
211678 Issued in NY
Practice address
2089 Julia Goldbach Ave
Ronkonkoma, NY 11779-6310
Phone
(631) 747-0580
NPI assigned
Apr 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 211678 NY Primary

Addresses

Primary practice location

2089 Julia Goldbach Ave
Ronkonkoma, NY 11779-6310

Mailing address

2089 Julia Goldbach Ave
Ronkonkoma, NY 11779-6310
Phone (631) 747-0580

Other identifiers 1

IdentifierTypeStateIssuer
634303269MedicaidNY

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

State licenses

LicenseStateTypeSpecialty
211678NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1651276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651276800000",
    "number": "1396480752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2089 JULIA GOLDBACH AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117796310",
            "telephone_number": "631-747-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2089 JULIA GOLDBACH AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117796310",
            "telephone_number": "631-747-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLINELLI",
        "first_name": "GINA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-30",
        "last_updated": "2022-04-30",
        "certification_date": "2022-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "211678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "634303269",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.