Individual provider Active NPI

Berta Kholdarova, FNP

  • Family Nurse Practitioner
  • Great Neck, NY
National Provider Identifier
1427923150
Registry record updated Feb 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F356828-01 Issued in NY
Practice address
560 Northern Blvd Ste 104
Great Neck, NY 11021-5100
Phone
(718) 444-8014
NPI assigned
Oct 10, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F356828-01 NY Primary

Addresses

Primary practice location

560 Northern Blvd Ste 104
Great Neck, NY 11021-5100

Mailing address

560 Northern Blvd Ste 104
Great Neck, NY 11021-5100
Phone (718) 444-8014

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260602003238 NY Practitioner - Nurse Practitioner 7719458694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2084 E 67TH St
Brooklyn, NY 11234-6008

7248 66TH St
Glendale, NY 11385-6966

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F356828-01NYMDFamily Nurse Practitioner

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": "1760054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1427923150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD STE 104",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "718-444-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD STE 104",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "718-444-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOLDAROVA",
        "first_name": "BERTA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-10",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F356828-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.