Provider Demographics
NPI:1669015780
Name:KONNER, ALI NICOLE
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:NICOLE
Last Name:KONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1613
Mailing Address - Country:US
Mailing Address - Phone:914-946-9559
Mailing Address - Fax:
Practice Address - Street 1:17 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-1613
Practice Address - Country:US
Practice Address - Phone:914-946-9559
Practice Address - Fax:914-946-9538
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator