NPIMap

Organization Active NPI

MBD Care LLC

  • Clinic/Center
  • Staten Island, NY
National Provider Identifier
1538042650
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MBD CARE LLC
Practice address
3350 Victory Blvd
Staten Island, NY 10314-6792
Phone
(917) 721-4494
NPI assigned
Jul 28, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Tatiana Kidanov, MS,RD,CDN,CDCESNPI 1871775171
Title
Owner/Managing Member
Phone
(917) 721-4494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3350 Victory Blvd
Staten Island, NY 10314-6792

Mailing address

36 Borman Ave
Staten Island, NY 10314-4957
Phone (917) 721-4494

Other practice location 1

1721 86th St
Brooklyn, NY 11214-2817
Phone (917) 721-4494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260218003337 NY Part B Supplier - Clinic/Group Practice 2365922242 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn, NY; Staten Island, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1753660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1538042650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 BORMAN AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103144957",
            "telephone_number": "917-721-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146792",
            "telephone_number": "917-721-4494"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1721 86th St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112142817",
            "country_code": "US",
            "telephone_number": "917-721-4494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MBD CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-28",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "KIDANOV",
        "authorized_official_first_name": "TATIANA",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "917-721-4494",
        "authorized_official_credential": "MS,RD,CDN,CDCES"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.