Active NPI
Kenneth R. Ustynoski, MD, FACS
- Specialist
- Shavertown, PA
National Provider Identifier
1922368398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD032192E
- Practice address
- 110 Ondish Rd
Shavertown, PA 18708-9415 - Phone
- (570) 696-4566
- NPI assigned
- May 20, 2012
- Last updated
- May 20, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | MD032192E | PA | Primary |
Addresses
Primary practice location
110 Ondish Rd
Shavertown, PA 18708-9415
Mailing address
110 Ondish Rd
Shavertown, PA 18708-9415
Phone (570) 696-4566
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD032192E | PA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337472000000",
"number": "1922368398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 ONDISH RD",
"city": "SHAVERTOWN",
"state": "PA",
"postal_code": "187089415",
"telephone_number": "570-696-4566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 ONDISH RD",
"city": "SHAVERTOWN",
"state": "PA",
"postal_code": "187089415",
"telephone_number": "570-696-4566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "USTYNOSKI",
"first_name": "KENNETH",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "MD, FACS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-20",
"last_updated": "2012-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "PA",
"license": "MD032192E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shavertown, PA
- The Harmony House Foundation, Inc
- Brian R Thomas, LMT
- Aphrodite J Togias, MD
- Dominick Peter Trombetta, PHARM.D, BCPS, CGP
- Trucksville Volunteer EMS Fire & Rescue Association
- Valor Counseling, LLC
- Wilkes Barre Behavioral Hospital Company LLC (Community Counseling Service of NEPA)
- Dale Arthur Wilkie, D.M.D.
- Lynn Ann Woods
- Haylie Jerylann Zelasko, PHARMD.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.