Active NPI
Adina Rusakov, MD
- Pediatrics Physician
- New York, NY
National Provider Identifier
1750887402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 312137
- Practice address
- 450 West End Ave
New York, NY 10024 - Phone
- (212) 769-3070
- Fax
- (212) 769-4703
- NPI assigned
- Apr 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 312137 | NY | Primary |
Addresses
Primary practice location
450 West End Ave
New York, NY 10024
Mailing address
475 St. Marks Ave #12a
Brooklyn, NY 11238
Phone (763) 498-3386
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190312003490 | NY | Order and Referring Only - Pediatric Medicine | 6800136730 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 312137 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662595200000",
"number": "1750887402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 ST. MARKS AVE #12A",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11238",
"telephone_number": "763-498-3386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 WEST END AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10024",
"telephone_number": "212-769-3070",
"fax_number": "212-769-4703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSAKOV",
"first_name": "ADINA",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-02",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "312137",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.