Dr. Roman Koldayev, M.D.
Internal Medicine in Lawrence, NY. Individual provider (NPI-1).
NPI number1790766970
StatusActive
Last updated in NPPESMar 19, 2012
Details
- NPI
- 1790766970
- Entity type
- Individual (NPI-1)
- Name
- Dr. Roman Koldayev
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 7, 2005
- Last updated
- Mar 19, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - INTERNAL MEDICINE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 206990 | NY | Yes |
Practice location
215 Rockaway TpkeLawrence, NY 11559-1216
Phone 516-374-5024 · Fax 516-374-5816
Mailing address
215 Rockaway TpkeLawrence, NY 11559-1216
Phone 516-374-5024 · Fax 516-374-5816
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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