| Sonoma Medical P.c. | |
|
21 Washington Ave Brentwood NY 11717-3215 | |
| (347) 624-3341 | |
| (347) 789-7415 |
| Full Name | Sonoma Medical P.c. |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 21 Washington Ave, Brentwood, New York |
| Authorized Official Name and Position | Arkady Yusupov (PRESIDENT) |
| Authorized Official Contact | 3476243341 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sonoma Medical P.c. 1361 Broadway Apt B32 Hewlett NY 11557-1342 Ph: (347) 624-3341 | Sonoma Medical P.c. 21 Washington Ave Brentwood NY 11717-3215 Ph: (347) 624-3341 |
| NPI Number | 1770198871 |
|---|---|
| Provider Enumeration Date | 09/15/2020 |
| Last Update Date | 09/15/2020 |
| Certification Date | 09/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770198871 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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