NPIMap

Individual provider Active NPI

Nikolay Tarkhanov, M.D.

  • Family Medicine Physician
  • Staten Island, NY
National Provider Identifier
1487782629
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
243184 Issued in NY
Practice address
15 Rome Ave
Staten Island, NY 10304-4317
Phone
(718) 816-0740
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 243184 NY Primary

Addresses

Primary practice location

15 Rome Ave
Staten Island, NY 10304-4317

Mailing address

15 Rome Ave
Staten Island, NY 10304-4317
Phone (718) 816-0740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070607000681 NY Practitioner - Family Practice 8022116482 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Calvary Hospital IncGroup PAC ID 9133010382, 50 clinicians

Practice addresses (Care Compare)

1740 Eastchester Rd
Bronx, NY 10461-2300
Phone (718) 518-2000

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214
  • New York-Presbyterian Hospital Hospital, New York, NY, CCN 330101
  • Memorial Hospital for Cancer and Allied Diseases Hospital, New York, NY, CCN 330154
  • South Brooklyn Health Hospital, Brooklyn, NY, CCN 330196

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
243184NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Calvary Hospital Inc CurrentSince Jan 30, 2013 Accepting new patients
Calvary Hospital Inc CurrentSince Jan 30, 2013 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
Healthcare Medical PC CurrentSince Oct 5, 2020 Accepting new patients
NYU Langone Hospitals CurrentSince May 1, 2017 Accepting new patients
NYU Langone Hospitals CurrentSince May 1, 2017 Accepting new patients
Medical Practice Associates PLLC PastSince Nov 15, 2006 Accepting new patients
NYU Lutheran Medical Center Past Accepting new patients

Locations

1740 Eastchester Rd
Bronx, NY 10461
Phone (718) 518-2000

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

150 55th St
Rm 3618
Brooklyn, NY 11220
Phone (718) 630-7477

1749 E 16th St
Ste 1
Brooklyn, NY 11229
Phone (718) 375-2333

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

Organizations & group practices 8

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.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1487782629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 ROME AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044317",
            "telephone_number": "718-816-0740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ROME AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044317",
            "telephone_number": "718-816-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARKHANOV",
        "first_name": "NIKOLAY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "243184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.