Individual provider Active NPI

Rosy Fatakhov

  • Licensed Practical Nurse
  • Rego Park, NY
National Provider Identifier
1225326226
Registry record updated Jul 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
304160 Issued in NY
Practice address
9715 64TH Rd
Rego Park, NY 11374-2250
Phone
(718) 459-5592
NPI assigned
Jul 12, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 304160 NY Primary

Addresses

Primary practice location

9715 64TH Rd
Rego Park, NY 11374-2250

Mailing address

9805 67TH Ave
Apt 4H
Rego Park, NY 11374-4969
Phone (646) 626-3214

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

LicenseStateTypeSpecialty
304160NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310428800000",
    "number": "1225326226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9805 67TH AVE",
            "address_2": "APT 4H",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744969",
            "telephone_number": "646-626-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9715 64TH RD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742250",
            "telephone_number": "718-459-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATAKHOV",
        "first_name": "ROSY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-12",
        "last_updated": "2011-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "304160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.