MEDICARE: BERTA KHOLDAROVA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F356828-01	NY

General Provider Information

NPI Number	:	1427923150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTA KHOLDAROVA FNP

Provider Business Mailing Address
First Line	:	560 NORTHERN BLVD STE 104
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5100
Country	:	US
Telephone Number	:	718-444-8014
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 NORTHERN BLVD STE 104
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5100
Country	:	US
Telephone Number	:	718-444-8014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	02/26/2026

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