Active NPI
Jency Johnikutty, PHARM-D
- Pharmacist
- Port Jefferson, NY
National Provider Identifier
1699084640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 055136
- Practice address
- 4331 Nesconset Highway
Port Jefferson, NY 11776 - Phone
- (631) 642-3019
- NPI assigned
- Sep 24, 2010
- Last updated
- Sep 30, 2010
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 055136 | NY | Primary |
Addresses
Primary practice location
4331 Nesconset Highway
Port Jefferson, NY 11776
Mailing address
908 N 1St St
New Hyde Park, NY 11040-2822
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055136 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285804800000",
"number": "1699084640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 N 1ST ST",
"city": "NEW HYDE PARK",
"state": "NY",
"postal_code": "110402822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4331 NESCONSET HIGHWAY",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "11776",
"telephone_number": "631-642-3019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNIKUTTY",
"first_name": "JENCY",
"credential": "PHARM-D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-24",
"last_updated": "2010-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "055136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
- John T. Mather Memorial Hospital (Mather Hospital)
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital (Breast Center)
- John T. Mather Memorial Hospital
- Jeena Elizabeth John
- Kerry Lynn Johnson, PA
- Cassandra Jones
- Lindsey Jones, MD
- Joseh P Boglia MD PC
- Joseph M. Gagliano, LCSW, P.C. (Avatar Counseling Innovations)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.