David Davydov, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

013921 Issued in NY

Practice address

10201 66TH Rd
Forest Hills, NY 11375-2029

Phone

(718) 830-4093

NPI assigned

May 12, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment
• Origin Pain Management and Medical Care, PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Brooklyn, NY
  • NPI 1871771402
  NPD (past)

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1396063566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752029",
            "telephone_number": "718-830-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVYDOV",
        "first_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "RPA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-12",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melody Lakeya Davis, MS
• Tamara Davitashvili, OTR/L
• Albert Davydov, DDS
• Bella Davydov, O.D.
• Bella Davydov
• Alena R Davydova
• Liliya Davydova, PHARMD
• Marina Davydova, PHARM.D.
• Olga Davydova, DPM
• Lavern Dawson

• Physician Assistant in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.