NPIMap

Individual provider Active NPI

Roman Koldayev, M.D.

  • Internal Medicine Physician
  • Lawrence, NY
National Provider Identifier
1790766970
Registry record updated Mar 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
206990 Issued in NY
Practice address
215 Rockaway Tpke
Lawrence, NY 11559-1216
Phone
(516) 374-5024
Fax
(516) 374-5816
NPI assigned
Nov 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 206990 NY Primary

Addresses

Primary practice location

215 Rockaway Tpke
Lawrence, NY 11559-1216

Mailing address

215 Rockaway Tpke
Lawrence, NY 11559-1216
Phone (516) 374-5024

Other identifiers 1

IdentifierTypeStateIssuer
01782470MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040717000168 NY Practitioner - Internal Medicine 2264411719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

310 Woods Ave
Suite 3
Oceanside, NY 11572-2146
Phone (718) 909-7665

Hospital & facility affiliations

  • Community Hospice, Inc, the Hospice, Albany, NY, CCN 331501
  • Hudson Valley Hospice Hospice, Poughkeepsie, NY, CCN 331521
  • Ellis Hospital Hospital, Schenectady, NY, CCN 330153
  • St Peter'S Hospital Hospital, Albany, NY, CCN 330057
  • Troy Victorian Rehabilitation & Nursing Care CNTR Nursing home, Troy, NY, CCN 335377
  • Premier Nursing and Rehab Center of Far Rockaway Nursing home, Far Rockaway, NY, CCN 335165
  • Ferncliff Nursing Home Co Inc Nursing home, Rhinebeck, NY, CCN 335405
  • Beach Terrace Care Center Nursing home, Long Beach, NY, CCN 335024
  • Brookhaven Rehab & Health Care Center L L C Nursing home, Far Rockaway, NY, CCN 335582

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
206990NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roman Koldayev Medical P C Internal Medicine CurrentSince Jul 8, 2013 Accepting new patients
Ovidiu a Krausz MD PC CurrentSince Apr 8, 2015 Accepting new patients
Albany County Past Accepting new patients
Beach Terrace Care Center Inc Past Accepting new patients
Troy Diamond Operations LLC Past Accepting new patients
Niskayuna Operating Co LLC Past Accepting new patients
New Surfside Nursing Home LLC Past Accepting new patients
Brookhaven Rehabilitation and Health Care Center LLC Past Accepting new patients
Ferncliff Nursing Home Company, Inc. Past Accepting new patients

Locations

310 Woods Ave
Ste 3
Oceanside, NY 11572
Phone (516) 632-2450

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Beach Terrace Care Center IncLong Beach, NY, CCN 335024 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2018
Sep 1, 2018
Pathway Rehabilitation and Special Care CenterNiskayuna, NY, CCN 335701001 Skilled nursing facility Corporate Director
Operational/Managerial Control
Adp of the SNF		 Dec 1, 2016
Dec 1, 2016
Dec 1, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1790766970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 ROCKAWAY TPKE",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591216",
            "telephone_number": "516-374-5024",
            "fax_number": "516-374-5816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 ROCKAWAY TPKE",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591216",
            "telephone_number": "516-374-5024",
            "fax_number": "516-374-5816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLDAYEV",
        "first_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "206990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01782470",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, NY

Sources for this page

Verify at the official NPI Registry.