Individual provider Active NPI

Karina Agajanov

  • Nurse Practitioner
  • Belleville, NJ
National Provider Identifier
1306487640
Registry record updated Oct 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ00966800 Issued in NJ
Practice address
140 Belmont Ave
Belleville, NJ 07109-1018
Phone
(973) 751-7870
NPI assigned
Oct 7, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ00966800 NJ Primary

Addresses

Primary practice location

140 Belmont Ave
Belleville, NJ 07109-1018

Mailing address

6 Leonard Ter
Roseland, NJ 07068-3726

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221021001415 NJ Order and Referring Only - Nurse Practitioner 7517333149

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26NJ00966800NJMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Roger Keshav MD PA PastSince Oct 13, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1306487640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 LEONARD TER",
            "city": "ROSELAND",
            "state": "NJ",
            "postal_code": "070683726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 BELMONT AVE",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091018",
            "telephone_number": "973-751-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGAJANOV",
        "first_name": "KARINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-07",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00966800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, NJ

Sources for this page

Verify at the official NPI Registry.