Provider Demographics
NPI:1124175377
Name:KONNICK, TONIANN (RN)
Entity type:Individual
Prefix:
First Name:TONIANN
Middle Name:
Last Name:KONNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TONIANN
Other - Middle Name:
Other - Last Name:CAPASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:33 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8941
Mailing Address - Country:US
Mailing Address - Phone:631-849-5115
Mailing Address - Fax:
Practice Address - Street 1:33 ROBIN RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8941
Practice Address - Country:US
Practice Address - Phone:631-849-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484263163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01709397Medicaid