Provider Demographics
NPI:1740823640
Name:KONI APRN FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:KONI APRN FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP
Authorized Official - Phone:860-729-8434
Mailing Address - Street 1:53 NEW BRITAIN AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1175
Mailing Address - Country:US
Mailing Address - Phone:860-729-4646
Mailing Address - Fax:860-785-8343
Practice Address - Street 1:53 NEW BRITAIN AVE STE 7
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1175
Practice Address - Country:US
Practice Address - Phone:860-729-4646
Practice Address - Fax:860-785-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care