Provider Demographics
NPI:1134124464
Name:SOBOL, IOURI (MD)
Entity Type:Individual
Prefix:DR
First Name:IOURI
Middle Name:
Last Name:SOBOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 CROPSEY AVE
Mailing Address - Street 2:SUITE#1LEFT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5861
Mailing Address - Country:US
Mailing Address - Phone:718-434-9938
Mailing Address - Fax:718-434-9939
Practice Address - Street 1:1706 CROPSEY AVE
Practice Address - Street 2:SUITE#1LEFT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5861
Practice Address - Country:US
Practice Address - Phone:718-434-9938
Practice Address - Fax:718-434-9939
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214341207R00000X
CAA065060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02007481Medicaid
NY02007481Medicaid
NY02007481Medicaid
NYH02018Medicare UPIN
NY51C051Medicare ID - Type Unspecified
NY51C053Medicare ID - Type Unspecified