Active NPI
Konstantin Mergold
- Family Nurse Practitioner
- New York, NY
National Provider Identifier
1417443151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 342597
- Practice address
- 120 E 16TH St FL 6
New York, NY 10003-2162 - Phone
- (800) 881-5101
- NPI assigned
- Jul 5, 2018
- Sex
- Male
- 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 Nurse Practitioner | 363LF0000X | 342597 | NY | Primary |
Addresses
Primary practice location
120 E 16TH St FL 6
New York, NY 10003-2162
Mailing address
2630 Cropsey Ave Apt 6K
Brooklyn, NY 11214-6721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200429001297 | NY | Order and Referring Only - Nurse Practitioner | 4486084761 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530748800000",
"number": "1417443151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2630 CROPSEY AVE APT 6K",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112146721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 E 16TH ST FL 6",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100032162",
"telephone_number": "800-881-5101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERGOLD",
"first_name": "KONSTANTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-05",
"last_updated": "2018-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "342597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.