Active NPI
Alina Fedorov
- Behavior Technician
- Staten Island, NY
National Provider Identifier
1205443744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 2873123
- Practice address
- 457 Adams Ave
Staten Island, NY 10306-5422 - Phone
- (347) 631-5441
- NPI assigned
- Sep 29, 2020
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 2873123 | NY | Primary |
Addresses
Primary practice location
457 Adams Ave
Staten Island, NY 10306-5422
Mailing address
457 Adams Ave
Staten Island, NY 10306-5422
Phone (347) 631-5441
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 256327544 | Other | NY | NYS DMV |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2873123 | NY | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601337600000",
"number": "1205443744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 ADAMS AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103065422",
"telephone_number": "347-631-5441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "457 ADAMS AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103065422",
"telephone_number": "347-631-5441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDOROV",
"first_name": "ALINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-29",
"last_updated": "2020-09-29",
"certification_date": "2020-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NY",
"license": "2873123",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS DMV",
"identifier": "256327544",
"state": "NY"
}
],
"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 Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.