=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770430449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KSENIA ADAMOV
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 DEFOREST DR
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-6557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-678-4662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 DEFOREST DR
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-6557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 692354-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------