Active NPI
Nisim Pakanaev, RN
- Registered Nurse
- Brooklyn, NY
National Provider Identifier
1770869695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 364624-1
- Practice address
- 1358 56TH St
Brooklyn, NY 11219-4616 - Phone
- (718) 851-7100
- Fax
- (718) 437-6397
- NPI assigned
- Oct 24, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 364624-1 | NY | Primary |
Addresses
Primary practice location
1358 56TH St
Brooklyn, NY 11219-4616
Mailing address
1358-56TH Street
Brooklyn, NY 11219
Phone (718) 851-7100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 364624-1 | NY | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jewish Board of Family and Children'S Services | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Brooklyn, NY
- NPI 1427222850
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319414400000",
"number": "1770869695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1358-56TH STREET",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11219",
"telephone_number": "718-851-7100",
"fax_number": "718-437-6397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1358 56TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112194616",
"telephone_number": "718-851-7100",
"fax_number": "718-437-6397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAKANAEV",
"first_name": "NISIM",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-24",
"last_updated": "2011-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "364624-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.