Individual provider Active NPI

Aleksey Yudanov, RN

  • Registered Nurse
  • Brooklyn, NY
National Provider Identifier
1417295478
Registry record updated Jan 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
664353 Issued in NY
Practice address
8684 20TH Ave Apt 2D
Brooklyn, NY 11214-3931
Phone
(646) 427-0543
NPI assigned
Jan 26, 2013
Last updated
Jan 27, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 664353 NY Primary

Addresses

Primary practice location

8684 20TH Ave Apt 2D
Brooklyn, NY 11214-3931

Mailing address

8684 20TH Ave Apt 2D
Brooklyn, NY 11214-3931
Phone (646) 427-0543

Other identifiers 1

IdentifierTypeStateIssuer
1417295478MedicaidNY

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
664353NYMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1359158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359244800000",
    "number": "1417295478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8684 20TH AVE APT 2D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112143931",
            "telephone_number": "646-427-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8684 20TH AVE APT 2D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112143931",
            "telephone_number": "646-427-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUDANOV",
        "first_name": "ALEKSEY",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-26",
        "last_updated": "2013-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "664353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417295478",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2013; 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.