Active NPI
Jeanine Marie Connolly, MS, ATC/L
- Athletic Trainer
- Pembroke, MA
National Provider Identifier
1417456369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2372
- Practice address
- 295 Old Oak St
Pembroke, MA 02359-1955 - Phone
- (857) 444-1200
- NPI assigned
- Feb 6, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2372 | MA | Primary |
Addresses
Primary practice location
295 Old Oak St
Pembroke, MA 02359-1955
Mailing address
56 Progressive Ave
West Bridgewater, MA 02379-1126
Phone (508) 243-5292
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2372 | MA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517875200000",
"number": "1417456369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 PROGRESSIVE AVE",
"city": "WEST BRIDGEWATER",
"state": "MA",
"postal_code": "023791126",
"telephone_number": "508-243-5292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "295 OLD OAK ST",
"city": "PEMBROKE",
"state": "MA",
"postal_code": "023591955",
"telephone_number": "857-444-1200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "JEANINE",
"middle_name": "MARIE",
"credential": "MS, ATC/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-06",
"last_updated": "2018-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "2372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.