Active NPI
Jennifer Conelli, M.A.,CCC-SLP
- Speech-Language Pathologist
- Staten Island, NY
National Provider Identifier
1699918938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 012771-1
- Practice address
- 551 Wilson Ave
Staten Island, NY 10312-3744 - Phone
- (718) 356-6778
- NPI assigned
- Apr 16, 2009
- Last updated
- Mar 7, 2016
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 012771-1 | NY | Primary |
Addresses
Primary practice location
551 Wilson Ave
Staten Island, NY 10312-3744
Mailing address
551 Wilson Ave
Staten Island, NY 10312-3744
Phone (718) 356-6778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151201000188 | NY | Practitioner - Qualified Speech Language Pathologist | 0648570424 | Practice locations: Staten Island, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012771-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1699918938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "551 WILSON AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123744",
"telephone_number": "718-356-6778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "551 WILSON AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123744",
"telephone_number": "718-356-6778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONELLI",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "M.A.,CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-16",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "012771-1",
"primary": true
}
],
"identifiers": [],
"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 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.