Provider Demographics
NPI:1033244686
Name:DR TOPROVER MEDICAL LLC
Entity Type:Organization
Organization Name:DR TOPROVER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-633-3823
Mailing Address - Street 1:207 OCEAN PKWY STE 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3211
Mailing Address - Country:US
Mailing Address - Phone:718-633-3823
Mailing Address - Fax:
Practice Address - Street 1:207 OCEAN PKWY STE 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3211
Practice Address - Country:US
Practice Address - Phone:718-633-3823
Practice Address - Fax:718-633-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01673665Medicaid
NYWEY611Medicare ID - Type Unspecified