Organization
MBD CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATIANA KIDANOV MS,RD,CDN,CDCES (OWNER/MANAGING MEMBER)
(917) 721-4494
Entity
Organization
Contact information
Practice address
3350 VICTORY BLVD, STATEN ISLAND, NY 10314-6792
(917) 721-4494
Mailing address
36 BORMAN AVE, STATEN ISLAND, NY 10314-4957
(917) 721-4494
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/28/2025
Last updated
07/28/2025
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