Larisa Jdanova, MSDE

Primary specialty

SpecialistTaxonomy code 174400000X

License

2598598 Issued in NY

Practice address

1580 Dahill Rd FL 2
Brooklyn, NY 11204-3573

Phone

(718) 375-2505

Fax

(718) 375-2472

NPI assigned

Aug 12, 2014

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

Other names 1

• Larisa Jdanova Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1649689977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 RACAL CT FL 3",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103145831",
            "telephone_number": "347-272-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 DAHILL RD FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112043573",
            "telephone_number": "718-375-2505",
            "fax_number": "718-375-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JDANOVA",
        "first_name": "LARISA",
        "credential": "MSDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-12",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "2598598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISA",
            "last_name": "JDANOVA",
            "credential": "MSDE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Specialist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.