Individual provider Active NPI

Leonard Roy Krilov, M.D.

  • Pediatric Infectious Diseases Physician
  • Mineola, NY
National Provider Identifier
1760403927
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X
License
159137 Issued in NY
Practice address
120 Mineola Blvd
Suite 210
Mineola, NY 11501-4073
Phone
(516) 663-9570
Fax
(516) 663-3793
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Infectious Diseases Physician 2080P0208X 159137 NY Primary

Addresses

Primary practice location

120 Mineola Blvd
Suite 210
Mineola, NY 11501-4073

Mailing address

222 Station PLZ N
Suite 611
Mineola, NY 11501-3808
Phone (516) 663-2532

Other identifiers 1

IdentifierTypeStateIssuer
01359122MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lkrilov238852@nyumc.direct-ci.com

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110305000039 NY Practitioner - Pediatric Medicine 1951583426 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
159137NYMDPediatric Infectious Diseases Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2025 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2025 Accepting new patients
Prohealth Care Associates LLP Past Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

222 Station Plz N
Ste 611
Mineola, NY 11501
Phone (516) 663-2532

120 Mineola Blvd
Ste 210
Mineola, NY 11501
Phone (516) 663-4600

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

1 Dakota Dr
Ste 218
New Hyde Park, NY 11042
Phone (516) 488-9700

1 Dakota Dr
Ste 100
New Hyde Park, NY 11042
Phone (516) 622-7337

Philadelphia, PA 19195

Interoperability endpoints

  • Direct secure messaging: lkrilov229686@direct.optum.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1760403927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 STATION PLZ N",
            "address_2": "SUITE 611",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013808",
            "telephone_number": "516-663-2532",
            "fax_number": "516-663-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MINEOLA BLVD",
            "address_2": "SUITE 210",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014073",
            "telephone_number": "516-663-9570",
            "fax_number": "516-663-3793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRILOV",
        "first_name": "LEONARD",
        "middle_name": "ROY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "NY",
            "license": "159137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01359122",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkrilov238852@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "120 Mineola Blvd",
            "address_2": "Suite 210",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115014073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.