Active NPI
Nicole Ann Koncelik, PHARMD
- Pharmacist
- Staten Island, NY
National Provider Identifier
1699098434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 053845-1
- Practice address
- 190 Gurley Ave
Staten Island, NY 10308-1505 - Phone
- (646) 772-7126
- NPI assigned
- Mar 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | 053845-1 | NY | Primary |
Addresses
Primary practice location
190 Gurley Ave
Staten Island, NY 10308-1505
Mailing address
190 Gurley Ave
Staten Island, NY 10308-1505
Phone (646) 772-7126
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053845-1 | Other | NY | PHARMACY LICENSE |
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 |
|---|---|---|---|
| 053845-1 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268006400000",
"number": "1699098434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 GURLEY AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103081505",
"telephone_number": "646-772-7126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 GURLEY AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103081505",
"telephone_number": "646-772-7126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONCELIK",
"first_name": "NICOLE",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-08",
"last_updated": "2010-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "053845-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "053845-1",
"state": "NY"
}
],
"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 8, 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.