1245493519 NPI number — IOURI SOBOL MEDICAL PC

Table of content: (NPI 1245493519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245493519 NPI number — IOURI SOBOL MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOURI SOBOL MEDICAL PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245493519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 CROPSEY AVE
Provider Second Line Business Mailing Address:
SUITE 1LEFT
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11214-5861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-434-9938
Provider Business Mailing Address Fax Number:
718-434-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1706 CROPSEY AVE
Provider Second Line Business Practice Location Address:
SUITE 1LEFT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214-5861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-9938
Provider Business Practice Location Address Fax Number:
718-434-9939
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOBOL
Authorized Official First Name:
IOURI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-434-9938

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  214341 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02004781 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134124464 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com