Individual provider Active NPI

Iosif Kaydanov, FNP

  • Family Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1831954791
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F353580 Issued in NY
Practice address
11 Ralph PL Ste 112
Staten Island, NY 10304-4408
Phone
(718) 954-2202
NPI assigned
Feb 19, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F353580 NY Primary

Addresses

Primary practice location

11 Ralph PL Ste 112
Staten Island, NY 10304-4408

Mailing address

2650 Ocean Pkwy Apt 11B
Brooklyn, NY 11235-7758
Phone (347) 466-1234

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260618002882 NY Practitioner - Nurse Practitioner 9830661032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4 Mountain LN
Holmdel, NJ 07733-1107

715 Twining Rd
Suite 108
Dresher, PA 19025-1884

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F353580NYMDFamily Nurse Practitioner

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.

NPI Registry JSON

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767744000000",
    "number": "1831954791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 OCEAN PKWY APT 11B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357758",
            "telephone_number": "347-466-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 RALPH PL STE 112",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044408",
            "telephone_number": "718-954-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAYDANOV",
        "first_name": "IOSIF",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-19",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F353580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.