Kseniya Roudakova, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

286549 Issued in NY

Practice address

451 Clarkson Ave.
Kings County Hospital
Brooklyn, NY 11203

Phone

(718) 245-4729

NPI assigned

May 21, 2013

Last updated

Jun 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: kroudakova211294@nychhc.direct-ci.com

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

• New York City Health and Hospitals Corporation

  dba Jacobi Medical Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1679587679
  NPD (past)

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1497191142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 CLARKSON AVE.",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-245-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 CLARKSON AVE.",
            "address_2": "KINGS COUNTY HOSPITAL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-245-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUDAKOVA",
        "first_name": "KSENIYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-21",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "286549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malka Rottenberg, MS ED
• Mario Rottenberg, MD
• Rachel NMN Rottenberg, LMSW
• Amber Rottman
• Eleni Rotziokos
• Betty-Ann Agatha Rougier
• Chantelle Cassie Rougier, NP
• Sara Roumani
• Isel Maria Roumbeas, MA CCC/SLP
• Cecilia Roumer

• Surgery Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.