Active NPI
Kim Fanizza
- Pharmacist
- Staten Island, NY
National Provider Identifier
1447420567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 042720-1
- Practice address
- 189 Bryant Ave
Staten Island, NY 10306-3103 - Phone
- (718) 979-4585
- NPI assigned
- Mar 4, 2008
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 042720-1 | NY | Primary |
| Pharmacist | 183500000X | PS29107 | FL | |
| Pharmacist | 183500000X | 28R102325600 | NJ |
Addresses
Primary practice location
189 Bryant Ave
Staten Island, NY 10306-3103
Mailing address
189 Bryant Ave
Staten Island, NY 10306-3103
Phone (718) 979-4585
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 042720-1 | Other | NY | RPH STATE LICENSE NUMBER |
| PS29107 | Other | FL | RPH LICENSE NUMBER |
| 28R102325600 | Other | NJ | RPH LICENSE NUMBER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| PS29107 | FL | MD | Pharmacist |
| 28R102325600 | NJ | MD | Pharmacist |
| 042720-1 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204588800000",
"number": "1447420567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "189 BRYANT AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103063103",
"telephone_number": "718-979-4585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "189 BRYANT AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103063103",
"telephone_number": "718-979-4585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANIZZA",
"first_name": "KIM",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-04",
"last_updated": "2008-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "042720-1",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS29107",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28R102325600",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RPH STATE LICENSE NUMBER",
"identifier": "042720-1",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RPH LICENSE NUMBER",
"identifier": "PS29107",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RPH LICENSE NUMBER",
"identifier": "28R102325600",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.